| ObjectiveChina has a higher incidence of liver cancer and liver resection remains the most important curative treatment of most patients at present. Whether liver function can recover has a direct impact on the effect of hepatic resection. Recently, the incidence of metabolie disease such as obesity, diabetes, hyperlipema is increasing, so fatty liver or hepatic steatosis becomes a common parenchymal liver disease. There are a lot reports of effect of fatty liver on liver resection, but they are mostly basic research. It still lacks reliable clinical data. Therefore our study firstly investigates the impact of liver steatosis on the perioperative and postoperative complications after hepatic resection and liver regeneration.Methods238 patients carried out hepatic reseetion in our hospital for the first time during 2010.10 - 2014.10 were choosed. We retrospectively analyzed the clinical course, pathological data and liver volume of preoperative and postoperative of these patients and compared the results of patients with steatosis to matched patients without steatosis to diseover the impact of liver steatosis on perioperative outeome of hepatic resection.ResultsWe find there were 126 patients who underwent left hepatectomy and 112 patients who underwent right hepatectomy. There were 22 patients with mild steatosis, 12 patients with marked steatosis in the 126 patients. There were 18 patients with mild steatosis,10 patients with marked steatosis in the 112 patients. The age and gender of the patients had no difference between these groups. The BMI of patients with steatosis was higher than the control (P<0.05). The triglyceride, total cholesterol, low densith lipoprotein, ALT, AST, uric acid of patients with steatosis were higher than the control (P＜0.05), and increased with the severity of fatty liver. HDL and AST/ALT of patients with steatosis was lower than the control (P<0.05), and reduced with the severity of fatty liver. Platelet count of patients with marked steatosis was lower than the control (P＜0.05), and there was no difference between the control and mild steatosis (P>0.05). The bilirubin levels of the patients had no difference between these groups (P>0.05). The correct diagnosis of fatty liver was 74.4% used the ratio of hepatic-splenic CT values. The correct diagnosis of fatty liver was 84.1% used the relative density of hepatic vessels. Marked hepatic steatosis increased the operative time, clamping time, blood loss, transfusion rate, ICU stay rate, postoperative hospital stay, total hospitalization time, which was associated with increased perioperative morbidity and perioperative morbidity needed medical therapy. Mild steatosis had no difference. On multivariate analysis, the study discovers that the steatosis was a risk factor for postoperative complications (P＜0.05). The ALT, AST, total bilirubin levels of the patients after the surgery had no difference between these groups (P>0.05). In the left or right hepatectomy group, mild steatosis had little influence on liver regeneration (P>0.05), moderate to severe steatosis significantly inhibited liver regeneration (P＜0.05). On multivariate analysis, the study discovers that the steatosis and hepatectomy amount were risk factors for postoperative liver regeneration (P＜0.05).Conclusion1. Moderate-to-severe hepatic steatosis increased the operative time, clamping time, blood loss, postoperative hospital stay, total hospitalization time,which was associated with an increased perioperative morbidity and perioperative morbidity needed medical therapy.Mild steatosis had little impact on partial hepatectomy.2. Mild steatosis has less impact on liver regeneration after partial hepatectomy. Moderate-to-severe hepatic steatosis plays the role of inhibiting liver fibrosis obviously. |
