转移性肝癌切除术后肝功能代偿不全的危险因素分析

The Risk Factors of Hepatic Dysfunction after Hepatectomy in Metastatic Liver Cancer

目的探讨转移性肝癌术后肝功能代偿不全的危险因素及其防治措施。方法回顾性分析2003年8月至2008年8月行手术切除的43例转移性肝癌患者的临床资料。结果术后肝功能轻度代偿不全(Child B级)20例(46.0%),重度代偿不全(Child C级)4例(9.3%)。术后1个月内死亡2例(4.6%)。单变量分析显示:癌灶大小(P<0.05)、切肝方式(P<0.01)和失血总量(P<0.01)与术后肝功能代偿不全有密切关系。结论癌灶多发、癌灶大、联合肝段切除术、失血过多是术后肝功能代偿不全主要的危险因素。术中严格控制出血、在保证完全切除肝肿瘤的同时尽可能保留功能正常的肝组织,是提高手术安全性和减少术后并发症的关键。

Objective To investigate the risk factors, prevention and treatment of hepatic dysfunction after hepatectomy in metastatic liver cancer （MLC）. Methods The clinical data of 43 cases with MLC undergoing hepatectomy between Aug. 2003 to Aug. 2008 were retrospectively analyzed. Results Mild liver dysfunction （Child-Pugh class B liver function） was oecured in 20 patients （46. 0%） and severe liver dysfuction （Child-Pugh class C liver function） in 4 patients （9.3%） during postoperative period. Two patients （4.6%） died within 1st postoperative month. The univariate analysis showed that the size of the tumor, type of hepatectomy and volume of intraoperative blood loss were related to the hepatic dysfunction after hepatectomy （P〈0.05,P〈0.01）. Conclusion Multiple nodules, the size of tumor, multiple segment resection and volumes of blood loss are the major risk factors of hepatic dysfunction. Control of bleeding and preservation of normal hepatic tissue as much as possible are the key to prevent liver dysfuction after hepatectomy in MLC patients.