124例肝癌切除术后并发胸腔积液的非条件Logistic回归分析

LOGISTIC REGRESSION ANALYSIS ON 124 CASES WITH PLEURAL FLUID AFTER HEPATECTOMY

目的探讨肝癌切除术后胸腔积液的成因及防治措施。方法对124例行肝癌切除术病例进行回顾性研究。结果肝癌术后胸腔积液发生率40.32%(50例),其中右侧胸腔积液82%(41例),肝癌术后胸腔积液的发生与手术部位、膈下积液、术后肝功能、第一肝门阻断时间、腹水、手术失血量有关(P<0.05);其中手术部位(OR=8.709)、肝门阻断时间(OR=3.924)、术中失血量(OR=2.043)、术后腹水(OR=0.215)、膈下积液(OR=1579.66)是影响胸腔积液发生的独立因素(P<0.05)。结论可以通过术前术后积极改善肝功能、改进手术操作方法、减少术中出血量、缩短肝门阻断时间、避免腹腔及膈下积液的发生来降低肝癌切除术后胸腔积液的发生率。

Objective To approach the sources of pleural fluid after hepatectomy.Methods 124 cases with primary hepatic carcinoma undergoing hepatectomy were selected for retrospective study.Results Pleural fluid emerged in 50 cases（40.32%）after hepatectomy,of which the right pleural effusion accounted for 82 percent（41 cases）;Pleural fluid after hepatectomy was related to operative site,fluid under diaphragm,hepatic function after operation,obstruative time of portal vein,ascites and volume of bleeding（P〈0.05）,meanwhile,operative site（OR=8.709）,fluid under diaphragm（OR=1579.66）,obstruative time of portal vein（OR=3.924）,ascites（OR=0.215）and volume of bleeding（OR=2.043） were independent factors（P〈0.05）.Conclusion To reduce the occurrence of pleural effusion after hepatectomy,we could improve the hepatic function preoperative and postoperative,refine the operation,reduce the volume of bleeding,decrtated obstruative time of portal vein and avoide the occurrence of fluid under diaphragm and ascites.