肝切除术后胸腔积液的成因及处理

Causes and treatment of pleural effusion after liver resection in patients with hepatocellular carcinoma

目的探讨肝切除术后常见的并发症胸腔积液的成因及处理方法。方法回顾分析连续９２例肝细胞癌行肝切除术的病例。术后发生胸腔积液３３例（胸腔积液组），其余５９例为非胸腔积液组。患者年龄、术前白蛋白水平、肝门阻断时间、肿瘤大小、肿瘤部位、门静脉癌栓、腹水、膈下积液、肝硬变等因素对胸腔积液形成的影响进行了分析。结果肿瘤部位、肝门阻断时间、肝硬变、膈下积液显著影响胸腔积液的形成。结论肝切除术后胸腔积液的发生与多种因素有关，缩短肝门阻断时间，减少膈下积液的发生将有助于降低这一并发症的发生。根据患者耐受程度，可相应选择控制体温、胸腔穿刺抽液、胸腔闭式引流等治疗方法。

AIMS\ Pleural effusion is a common complication after liver resections. The causes and treatment were studied. METHODS\ A consecutive series of 92 patients with primary hepatocarcinoma, who submitted to liver resections, were reviewed. Pleural effusion occured in 33 patients(35.9%), and didn't occur in 59 patients. Eight factors which may contribute to the complication were analysed: age, preoperative serum albumen level, liver ischemia time, tumor size, tumor location, subphrentic accumulation, ascites, portal vein emboli and cirrhosis. RESULTS\ Significant differences were found in tumor location, subphrentic accumulation, liver ischemia time and cirrhosis between the two groups. CONCLUSIONS\ Several factors may contribute to the occurence of pleural effusion after liver resection. Reducing liver ischemia time and decreasing subphrentic accumulation would be help to decrease this complication. Several treatments can be chosen according to the tolerance of the patients.