肝癌切除联合脾脏定量微波消融治疗肝癌合并脾功能亢进的感染因素分析

Risk factors of infections after hepatectomy for hepatocellular carcinoma combined with quantitative microwave ablation of spleen in treatment of hepatocellular carcinoma associated with hypersplenism

目的探讨肝癌切除联合脾脏定量微波消融治疗肝癌合并脾功能亢进术后感染的相关危险因素,为临床治疗提供参考。方法收集肝癌切除联合脾脏定量微波消融治疗肝癌合并脾功能亢进的90例患者临床资料,进行回顾性调查研究,应用病例对照研究方法,采用单因素分析以及非条件logistic逐步回归的方法分析术后感染相关危险因素。结果术后感染发生率为23.33%,年龄、术前肝功能、消融范围、手术持续时间、术中失血量等5项因素是肝癌切除联合脾脏定量微波消融治疗肝癌合并脾功能亢进术后感染显著相关的危险因素;年龄≥60岁的患者术后感染率为27.08%,术前肝功能C级的患者术后感染率为38.46%,消融范围<20%或>40%的患者术后感染率分别为33.33%和42.85%,手术时间≥4h的患者术后感染率为34.78%,术中失血>2000ml的患者术后感染率为40.00%。结论术前调整肝功能、选择合适的微波消融范围、缩短手术持续时间,控制术中出血量,术后合理使用抗菌药物等可防止肝癌切除联合脾脏定量微波消融治疗肝癌合并脾功能亢进术后感染的发生。

OBJECTIVE To investigate the related risk factors of the infections after the hepatectomy for hepatocellular carcinoma combined with quantitative microwave ablation of spleen in the treatment of hepatocellular carcinoma associated with hypersplenism so as to provide basis for the clinical treatment. METHODS A total of 90 patients with hepatocellular carcinoma associated with hypersplenism who were treated by hepatectomy for hepatocellular carcinoma combined with quantitative microwave ablation of spleen were collected to retrospectively investigate. By means of the case-control study, the univariate analysis and the non-conditional logistic regression analysis were performed to analyze the related risk factors for the postoperative infections. RESULTS The incidence of infections was 23.33%, and the age, liver function before operation, the range of ablation, operation duration, and the intraoperative blood loss were the risk factors associated with the postoperative infections in the patients with hepatocellular carcinoma associated with hypersplenism after the hepatectomy for hepatoeellular carcinoma combined with quantitative microwave ablation of spleen. The incidence of the postoperative infections was 27.08% in the patients with more than 60 years of age, 38. 46% in the patients with C level of the preoperative liver function, 33.33% in the patients with the ablation range less than 20%, 42.85% in the patients with the ablation range more than 40%, 34.78% in the patients with the operation duration more than 4 hours, and 40.00% in the patients with the intraoperative blood loss more than 2000ml. CONCLUSION Adjusting the liver function before operation, choosing a suitable range of ablation, shortening the operation duration, controlling the mount of blood loss, and reasonably using antibiotics can prevent the infections after the hepatectomy for hepatocellular carcinoma combined with quantitative microwave ablation of spleen in treatment of hepatocellular carcinoma associated with hypersplenism.