肺门周围胆管癌（pCCA）的手术切除与高手术风险相关。已有肝病的患者肝再生受损可能会导致肝切除术后肝功能衰竭（PHLF）和术后死亡率。本研究旨在确定 pCCA 患者肝脂肪变性和纤维化的发生率及其与 PHLF 和术后 90 天死亡率的关系。该研究纳入了 2000 年至 2021 年间来自三家三级转诊医院的因 pCCA 接受主要肝切除术的患者。对肝脏脂肪变性和纤维化进行组织病理学评估。主要结局是 PHLF 和 90 天死亡率。在 401 名纳入患者中，334 名患者 (83.3%) 不存在脂肪变性，58 名患者 (14.5%) 为轻度脂肪变性，9 名患者 (2.2%) 为中度至重度脂肪变性。 92 名患者（23.1%）无纤维化，150 名患者（37.6%）出现门静脉周围纤维化，123 名患者（30.8%）出现间隔纤维化，34 名患者（8.5%）出现胆汁性肝硬化。脂肪变性（≥ 5%）与 PHLF（比值比 [OR] 1.36；95% 置信区间 [CI] 0.69-2.68）或 90 天死亡率（OR 1.22；95% CI 0.62-2.39）无关。纤维化（即门静脉周围、间隔或胆汁性肝硬化）与 PHLF（OR 0.76；95% CI 0.41-1.41）或 90 天死亡率（OR 0.60；95% CI 0.33-1.06）无关。 PHLF 的独立危险因素是术前胆管炎（OR 2.38；95% CI 1. 36-4.17）和未来肝脏残余小于 40%（OR 2.40；95% CI 1.31-4.38）。 90 天死亡率的独立危险因素是年龄 65 岁或以上（OR 2.40；95% CI 1.36-4.23）和术前胆管炎（OR 2.25；95% CI 1.30-3.87）。证明了 pCCA 切除后肝脏脂肪变性或纤维化与术后结果之间的关系。© 2023。作者。

Surgical resection for perihilar cholangiocarcinoma (pCCA) is associated with high operative risks. Impaired liver regeneration in patients with pre-existing liver disease may contribute to posthepatectomy liver failure (PHLF) and postoperative mortality. This study aimed to determine the incidence of hepatic steatosis and fibrosis and their association with PHLF and 90-day postoperative mortality in pCCA patients.Patients who underwent a major liver resection for pCCA were included in the study between 2000 and 2021 from three tertiary referral hospitals. Histopathologic assessment of hepatic steatosis and fibrosis was performed. The primary outcomes were PHLF and 90-day mortality.Of the 401 included patients, steatosis was absent in 334 patients (83.3%), mild in 58 patients (14.5%) and moderate to severe in 9 patients (2.2%). There was no fibrosis in 92 patients (23.1%), periportal fibrosis in 150 patients (37.6%), septal fibrosis in 123 patients (30.8%), and biliary cirrhosis in 34 patients (8.5%). Steatosis (≥ 5%) was not associated with PHLF (odds ratio [OR] 1.36; 95% confidence interval [CI] 0.69-2.68) or 90-day mortality (OR 1.22; 95% CI 0.62-2.39). Neither was fibrosis (i.e., periportal, septal, or biliary cirrhosis) associated with PHLF (OR 0.76; 95% CI 0.41-1.41) or 90-day mortality (OR 0.60; 95% CI 0.33-1.06). The independent risk factors for PHLF were preoperative cholangitis (OR 2.38; 95% CI 1. 36-4.17) and future liver remnant smaller than 40% (OR 2.40; 95% CI 1.31-4.38). The independent risk factors for 90-day mortality were age of 65 years or older (OR 2.40; 95% CI 1.36-4.23) and preoperative cholangitis (OR 2.25; 95% CI 1.30-3.87).In this study, no association could be demonstrated between hepatic steatosis or fibrosis and postoperative outcomes after resection of pCCA.© 2023. The Author(s).