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Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy

Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 507-512页

作者： Filippo Filicori Xavier M Keutgen Matteo Zanello Giorgio Ercolani Salomone Di Saverio federico sacchetti Antonio Daniele Pinna Gian Luca Grazi General Surgery and Transplant Unit Department of General Surgery and Organ TransplantationUniversity of BolognaVia Massarenti 940138 BolognaItaly Department of Surgery New York Presbyterian Hospital Weill Cornell Medical College Department of Surgery New York Presbyterian HospitalWeill Cornell Medical College Department of Emergency Surgery Maggiore HospitalL.go Nigrisoli 240133 BolognaItaly Hepato-Biliary Surgery Unit Istituto Nazionale Tumori Regina ElenaVia Elio Chianesi5300144 RomaItaly

BACKGROUND: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. METHODS: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. RESULTS: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT65 years, HCV, reoperation, andrenal failure were significant predictors of overall intra-hospital mortality on multivariate analysis. CONCLUSIONS: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population.

关键词： hepatectomy liver diseases liver failure postoperative complications prothrombin time bilirubin

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