原发性肝癌术后肝功能失代偿的相关危险因素研究

Risk factor analysis of liver function discompensation for hepatocellular carcinoma after hepatectomy

目的研究原发性肝癌切除术后肝功能失代偿的主要相关危险因素。方法回顾性分析75例原发性肝癌手术切除病例,研究术后肝功能失代偿与临床病理参数的关系。结果75例原发性肝癌切除手术患者,分别施行肝段、叶、半肝及扩大半肝切除,其中半肝切除21例,扩大半肝切除7例。14例出现术后肝功能失代偿,发生率18·67%,其中2例死于肝功能衰竭,死亡率2·67%。单变量分析提示肝切除量、癌灶长径、术中出血量、手术时间、术前肝硬化程度、Child分级、AST、ALT、TBIL及术后首日腹腔引流量(FDAD)、AST、TBIL与术后肝功能失代偿的发生具有明显相关性。多变量Logistic回归分析提示肝切除量、术中出血量、肝硬化程度是术后肝功能失代偿发生的独立危险因素。结论评估肝切除术后肝功能失代偿的危险性需结合肝功能指标综合分析,肝切除量、肝硬化程度是主要的、较好的评估指标。术中应控制出血和肝切除量,缩短手术时间以降低肝功能失代偿的发生率。

Objective To evaluate the main risk factors related to liver function discompensation for hepatocellular carcinoma after hepatectomy. Methods Clinical data of 75 hepatocellular carcinoma cases receiving hepatectomy were analyzed retrospectively. The main clinical risk factors and laboratorial result were analyzed. Results 75 patients conducted hepatectomy ： seg-mental resection,lobectomy, hemi-hepatectomy and extensive hemi-hepatectomy. Totally 14 cases occurred discompensation after hepatectomy and 2 of them died of liver function failure. The mortality rate was 2.67%. The univariate analysis revealed that the volume of hepatectomy, tumor size, operative bleeding, operative duration, liver cirrhosis, Child grade, preoperative AST, ALT, TBIL, first day abdomen drainage,postoperative AST, TBIL reached the statistical significance. The multivariate logistic regression analysis revealed that the volume of hepatectomy, operative bleeding, liver cirrhosis had an independent influence on liver function discompensation. Conclusion To evaluate the risk of liver function discompensation for hepatocellular carcinoma after hepatectomy need comprehensive analysis of different clinical and laboratorial parameters while the volume of hepatectomy and the liver cirrhosis are the main and important factors . Decreasing blood loss, controlling the volume of hepatectomy and reducing operative duration play the key roles for preventing postoperative liver function discompensation.