Objective: To analyze the impact of high or low levels of anatomical risk of hepatic alveolar echinococcosis (HAE) on complications after radical resection.
Methods: The baseline, surgical, and complication data were retrospectively collected from hepatic alveolar echinococcosis patients who underwent radical resection at the Ganzi Branch Hospital, West China Hospital, Sichuan University from 2015 to 2022. The patients were divided into anatomical low-risk (ALR) and anatomical high-risk (AHR) groups based on the PNM staging system designed by the World Health Organization (WHO-PNM). Complications were analyzed according to the Clavien-Dindo classification. Univariate and multivariate logistic regression analyses were performed to assess the effect of high and low risks of lesion anatomy on complications.
Results: Radical surgery was performed in 216 HAE patients and 102 of whom were in the AHR group. The median operative time was 230 (175, 300) min, the median intraoperative blood loss was 600 mL, and 129 (59.7%) patients developed complications. The complication rate was 73.5% (75/102) in the AHR group and 47.4% (54/114) in the ALR group, demonstrating statistically significant difference ( P<0.05). The incidence of serious complications was 36.3% (37/102) in the AHR group and 13.2% (15/114) in the ALR group, demonstrating statistically significant difference ( P<0.05). There was significant difference in the proportions of patients having postoperative complications of bile leak, anemia, fever, pleural effusion and ascites between the AHR group and the ALR group ( P<0.05). Multivariate logistic regression analysis suggested that AHR was the only independent risk factor for complications, including bile leak, anemia, fever, and pleural effusion, and severe complications.
Conclusion: The anatomical risk of hepatic alveolar echinococcosis is independently associated with the development of multiple postoperative complications, and physicians should choose surgical procedures cautiously according to the actual situation when dealing with patients defined as AHR according to WHO-PNM.
目的: 分析肝泡型包虫病解剖风险高低对根治性切除术后并发症的影响。
方法: 回顾性收集2015–2022年四川大学华西医院甘孜分院接受根治性切除的肝泡型包虫病患者基线、手术以及并发症资料，依据WHO-PNM分期系统将患者分为解剖低危组和解剖高危组，并发症根据Clavien-Dindo分级进行研究。单因素、多因素logistic回归分析评估包虫解剖风险高低危对并发症的影响。
结果: 216例肝泡型包虫病患者行根治性手术，其中解剖高危组患者102例。手术时间中位数230 min，术中失血量中位数600 mL，129例（59.7%）患者出现并发症。解剖高危组并发症发生率73.5%（75/102），解剖低危组47.4%（54/114），差异有统计学意义（P<0.05）。解剖高危组严重并发症发生率36.3%（37/102），解剖低危组13.2%（15/114），差异有统计学意义（P<0.05）。解剖高危组和解剖低危组术后发生胆漏、贫血、发热、胸腔积液和腹水并发症的比例差异有统计学意义（P<0.05）。多因素logistic回归分析提示解剖风险高低是并发症（胆漏、贫血、发热、胸腔积液）和严重并发症唯一的独立危险因素。
结论: 肝泡型包虫病的解剖风险高低与术后多种并发症发生独立相关，医师处置WHO-PNM解剖高危组患者时应根据实际情况慎重选择手术。
Keywords: Anatomy; Hepatic alveolar echinococcosis; Post operative complications; Radical resection.
Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).