肝癌肝切除术后并发胸腔积液影响因素临床分析

Factors related to pleural effusion following hepatectomy for liver cancer

目的分析肝癌肝切除术后胸腔积液的发生率及其影响因素,探讨防治肝切除术后并发胸腔积液的可能措施。方法回顾性分析我院2002年1月～2007年7月间行肝切除术的226例肝癌的临床资料。运用χ2检验分析其年龄、性别、病理类型、术前肝功能分级、肿瘤直径、肿瘤部位、手术时间、失血量、肝门阻断时间、切除方式、术后腹水量与术后胸腔积液发生率的关系。结果肝癌肝切除术后胸腔积液发生率为23.01%。从χ2检验的结果可见:在α=0.05水平上,术后并发胸腔积液的主要影响因素为:肿瘤部位、手术时间、术中失血量、肝门阻断时间、肝切除术式、术后腹水量(P<0.01)。结论严格掌握手术适应证,加强术前及术后护肝治疗;术中不盲目扩大切除范围,尽可能在较短的时间内完成肝癌的切除;尽量缩短肝门阻断时间,可以减少术后胸腔积液的发生。

Objective To study the incidence and risk factors related to pleural effusion following hepatectomy for liver cancer and investigate the methods to evaluate these factors. Methods Two hundred and twenty-six cases admitted on our hospital from Jan. 2002 to July 2007 are retrospectively analyzed. The factors related to postoperative pleural effusion were identified by Chi-square test with SPSS 13.0. Results The incidence of postoperative pleural effusions following hepateetomy was 23.01%. Univariate analysis showed significant differences in tumor location,operative time, blood loss amount,Pringle manoeuvre length, modus of hepatectomy and postoperative ascites collection（P〈 0. 01）. Conclusion To strictly grasping hepatectomy indication, enhancing the liver protecting effects preoperatively and postoperatively, not expanding the excision scope blindly during operation, completing hepatectomy in the short time as soon as possible and reducing Pringle manoeuvre length may reduce the occurrence of postoperative pleural effusion.