Abdominal operations in patients with cirrhosis: Still a major surgical challenge

被引:278
作者
Mansour, A [1 ]
Watson, W [1 ]
Shayani, V [1 ]
Pickleman, J [1 ]
机构
[1] LOYOLA UNIV,STRITCH SCH MED,DEPT SURG,MAYWOOD,IL 60153
关键词
D O I
10.1016/S0039-6060(97)90080-5
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Hepatic transplantation and portasystemic shunts can be safely performed in patients with advanced liver disease, whereas other abdominal procedures appear to have a much higher mortality rate. This study reviews the outcomes of patients with cirrhosis after the full spectrum of abdominal operations. Methods. In a 12-year period, 92 patients diagnosed with cirrhosis required either an emergent or elective abdominal operation. There were four categories of operations: cholecystectomy in 17 patients, hernia in 9, gastrointestinal tract in 54, and other procedures in 12. Fifty-five clinical, laboratory, and operative variables were analyzed to identify factors predictive of poor outcome. Results. Coagulopathy developed in 24 patients (27%) and sepsis in 15 (16%). The mortality rate after emergent operations was 50%, compared to 18% for elective cases (p = 0.001). Other factors that predicted mortality included the presence of ascites (p = 0.006), encephalopathy (p = 0.002), and elevated prothrombin time (p = 0.021). The mortality in Child's class A patients was 10%, compared to 30% in class B and 82% in class C patients. Conclusions. Patients with cirrhosis undergoing elective or emergent operations are at a significant risk of developing postoperative complications leading to death. The most accurate predictor of outcome is the patient's preoperative Child's class.
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页码:730 / 735
页数:6
相关论文
共 16 条
[11]   THE SURGICAL RISK OF COLECTOMY IN PATIENTS WITH CIRRHOSIS [J].
METCALF, AMT ;
DOZOIS, RR ;
WOLFF, BG ;
BEART, RW .
DISEASES OF THE COLON & RECTUM, 1987, 30 (07) :529-531
[12]  
MORGENSTERN L, 1992, ARCH SURG-CHICAGO, V127, P400
[13]   IS PORTAL-SYSTEMIC SHUNT WORTHWHILE IN CHILDS CLASS-C CIRRHOSIS - LONG-TERM RESULTS OF EMERGENCY SHUNT IN 94 PATIENTS WITH BLEEDING VARICES [J].
ORLOFF, MJ ;
ORLOFF, MS ;
RAMBOTTI, M ;
GIRARD, B ;
MCDERMOTT, WV ;
LANGER, B ;
TUROCOTTE, JG ;
LEVINE, BA ;
SARFEH, IJ .
ANNALS OF SURGERY, 1992, 216 (03) :256-268
[14]   UMBILICAL HERNIA REPAIR IN PATIENTS WITH CIRRHOSIS - NO EVIDENCE FOR INCREASED INCIDENCE OF VARICEAL BLEEDING [J].
PESCOVITZ, MD .
ANNALS OF SURGERY, 1984, 199 (03) :325-327
[15]   OPEN CHOLECYSTECTOMY - A CONTEMPORARY ANALYSIS OF 42,474 PATIENTS [J].
ROSLYN, JJ ;
BINNS, GS ;
HUGHES, EFX ;
SAUNDERSKIRKWOOD, K ;
ZINNER, MJ ;
CATES, JA .
ANNALS OF SURGERY, 1993, 218 (02) :129-137
[16]  
SIRINEK KR, 1987, ARCH SURG-CHICAGO, V122, P271