老年肝癌切除术后肝功能损伤的相关因素分析

Analysis of the Relative Factors of Postoperative Hepatic Function Damage after Resection of Hepatocellular Carcinoma in Senile People

目的研究老年肝癌切除术后肝功能损伤的相关因素。方法回顾性分析62例老年肝癌切除患者的临床资料,采用单因素分析和多元逐步回归模型分析与肝癌切除术后肝功能损伤的相关因素。结果老年肝癌切除术后肝功能损伤的发生率为32.6%,因肝功能衰竭死亡1例,病死率为1.6%。单因素分析显示肝门阻断、术中出血、术中输血量及肿瘤大小与术后肝功能损伤有关。多元逐步回归模型分析显示肝门阻断是决定术后肝功损伤的独立因素。结论老年肝癌切除术后肝功能损伤的主要原因是肝门阻断和术中大出血,提高手术技能,缩短肝门阻断时间和减少术中出血是预防老年肝癌切除术后肝功能损伤的主要措施。

Objective To investigate the factors of hepatic failure after hepatectomy in the patients with hepatocellular carcinoma in senile people. Methods Hepatic function of 62 patients with hepatocellular carcinoma admitted between 2003 and 2005 was analyzed retrospectively. Single - variant and multivariate stepwise regression models were used to analyze the factors associated with postoperative hepatic function damage after resection of hepatocellular carcinoma in senile people. Results The morbidity rate and mortality rate were 32. 6% and 1.6% respectively. Single - variant analysis showed that Pringle maneuver, intraoperative bleeding, blood transfusion and size of tumor were associated with postoperative hepatic function damage in senile people. Furthermore, multivariate stepwise regression analysis revealed that Pringle maneuver was the independent risk factor associated with postoperative hepatic function damage after resection of hepatocellular carcinoma in senile people. Conclusion The major causes for postoperative hepatic function failure in resection of hepatocellular carcinoma in senile people are the Pringle maneuver and intraoperative bleeding. So the main ways to prevent the postoperative hepatic function damage in senile people are to improve the operative skill, shorten the time of the Pringle maneuver, and reduce the intraoperative bleeding.