在肝门部胆管癌手术中确定术中失血目标。尽管大量出血可能会对术后病程产生负面影响，但为减少其不良影响而制定的术中出血目标值尚不清楚。本研究纳入了2010年至2019年间因肝门部胆管癌接受大肝叶切除术的患者。根据体重调整术中失血量(aBL)，并利用综合并发症指数(CCI)评估总体术后并发症。采用受限立方样条回归分析评估aBL对CCI的影响。共纳入425名患者。aBL的中位数为17.8(四分位距为11.8-26.3)ml/kg，CCI为40.6(33.7-49.5)。63名(14.8%)患者的aBL < 10 ml/kg，近半(45.4%)患者的aBL在10≤aBL < 20 ml/kg范围内，37名(8.7%)患者的aBL > 40 ml/kg。受限立方样条回归分析显示aBL与CCI之间存在非线性递增关系；当aBL低于10ml/kg时，CCI保持不变；当aBL在10至20ml/kg范围内时，CCI显著增加；当aBL超过20ml/kg时，CCI逐渐增加。这些约为10和20ml/kg的拐点几乎与递归分区技术确定的截断值一致。在调整其他术后病程风险因素后，受限立方样条回归确定了类似的模型。在肝门部胆管癌切除术后，aBL对CCI有非线性加剧效应。aBL的主要目标应该是小于10ml/kg，以最小化CCI。版权所有©2023 Wolters Kluwer Health， Inc.。保留所有权利。

To determine the goal of intraoperative blood loss in hepatectomy for perihilar cholangiocarcinoma.Although massive bleeding can negatively affect the postoperative course, the target value of intraoperative bleeding to reduce its adverse impact is unknown.Patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2010 and 2019 were included. Intraoperative blood loss was adjusted for body weight (aBL), and the overall postoperative complications were evaluated by the comprehensive complication index (CCI). The impact of aBL on CCI was assessed by the restricted cubic spline regression.A total of 425 patients were included. The median aBL was 17.8 (interquartile range, 11.8-26.3) mL/kg, and the CCI was 40.6 (33.7-49.5). Sixty-three (14.8%) patients had an aBL<10 mL/kg, nearly half (45.4%) of the patients were in the range of 10≤aBL<20 mL/kg, and 37 (8.7%) patients had an aBL>40 mL/kg. The spline regression analysis showed a non-linear incremental association between aBL and CCI; CCI remained flat with an aBL under 10 mL/kg; increased significantly with an aBL ranging from 10 to 20 mL/kg; grew gradually with an aBL over 20 mL/kg. These inflection points of approximately 10 and 20 mL/kg were almost consistent with the cut-off values identified by the recursive partitioning technique. After adjusting for other risk factors for the postoperative course, the spline regression identified a similar model.aBL had a non-linear aggravating effect on CCI after hepatectomy for perihilar cholangiocarcinoma. The primary goal of aBL should be less than 10 mL/kg to minimize CCI.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.