老年人肝癌切除术围手术期肝功能损伤的临床研究

Clinical study of hepatic damage during perioperative period of liver resection for hepatic carcinoma in elderly patients

目的 研究老年人原发性肝癌肝切除术围手术期肝功能损伤的原因及防治措施,以提高其临床疗效.方法 回顾性分析原发性肝癌肝切除病例62例,老年组32例,非老年组30例,采用单因素分析和多元逐步回归模型分析围手术期老年组与非老年组、肝门阻断组和非阻断组、出血量多组（≥500 ml）和出血量少组（＜500 ml）肝功能损害的影响因素.结果 老年肝癌切除术后肝功能损伤的发生率为32.6%,肝功能衰竭的病死率为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损伤有关.多元逐步回归模型显示肝门阻断的标准化回归系数0.314,（t=2.272,P＜0.05）,肝门阻断是决定术后肝功能损伤的独立因素.结论 老年肝癌肝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人肝癌术后肝功能损伤的主要措施.

Objective To investigate the causes and preventive measures of hepatic failure during perioperative period of liver resection for primary hepatic carcinoma in the elderly patients, and to explore its diagnosis and treatment. Methods The 62 patients with primary hepatic carcinoma undergoing hepatectomy were analyzed retrospectively, and they were divided into two groups： elderly group （age≥60 years） and non-elderly group （age〈60 years）. The influencing factors for damage of hepatic function were analyzed using single variant and multivariate stepwise regression analysis in elderly and non-elderly group, pringle maneuver and non-pringle maneuver group, more （≥500 ml）and less （〈500 ml） amount of bleeding group. Results The incidence of hepatic damage and mortality rate induced by hepatic failure were 32. 6% and 1.6% respectively after liver resection for primary hepatic carcinoma. Single variant analysis showed that pringle maneuver, intraoperative blood loss, blood transfusion and size of tumor were associated with postoperative hepatic function.Furthermore, multivariate stepwise regression analysis revealed that pringle maneuver was the independent risk factor associated with postoperative hepatic function （β = 0. 314, t= 2. 272, P 〈0. 05）. Conclusions The postoperative hepatic damage is significantly correlated with pringle maneuver and intraoperative bleeding in liver resection for hepatocellular carcinoma in senile people.And improving operative techniques, shorting the time of pringle maneuver, decreasing intraoperative bleeding were the main preventive measures for hepatic damage after liver resection for primary hepatic carcinoma in the elderly patients.