原发性肝癌精准肝切除术后应用羟乙基淀粉的临床研究

Clinical study of hydroxyethyl starch solution treatment for HCC patients after hepatectomy

目的探讨精准肝切除术后应用羟乙基淀粉(130/0.4)对合并肝硬化的原发性肝癌患者术后恢复的影响。方法采用前瞻性、非随机对照研究的方法,将自2009年1月—2010年5月,在南京大学医学院附属鼓楼医院行肝切除术的108例合并肝硬化的原发性肝癌患者,分为(1)羟乙基淀粉治疗组:54例。术后3 d内使用羟乙基淀粉(130/0.4)500 mL/d;(2)白蛋白治疗组:54例。术后3 d内使用人血白蛋白者10 g/d。比较两组患者术前、术后2,4,7 d的ALT,AST,白蛋白,C-反应蛋白(CRP)水平,以及术后并发症发生率,住院天数。结果术前两组临床资料、肝切除类型、范围及术中出血量均具有可比性(均P>0.05)。与白蛋白治疗组比较,羟乙基淀粉治疗组患者在术后2,4,7 d的ALT,AST,白蛋白水平,术后住院天数均无统计学差异(P>0.05)。羟乙基淀粉治疗组术后2 d的CRP较白蛋白治疗组有所下降,差异有统计学意义(t=6.351,P=0.000);术后4,7 d的CRP也有所下降,但无统计学差异(P>0.05)。术后并发症包括切口感染、胸腔积液、腹腔积液、肺部感染、腹腔出血、胆汁漏及腹腔感染。羟乙基淀粉组共有28例发生一种或两者上述并发症,发生率为51.9%(28/54),白蛋白组共有39例发生一种或两者上述并发症,发生率为72.2%(39/54),两组比较有统计学差异(χ2=4.757,P=0.047)。结论羟乙基淀粉在合并肝硬化的原发性肝癌患者行肝切除术后早期应用可以有效节约白蛋白的用量,控制术后的炎症反应,降低围手术期并发症的发生率。

Objective To investigate the impact of hydroxyethyl starch solution（HES130/0.4）therapy after hepatectomy for HCC patients associated with liver cirrhosis.Methods Between January 2009 and May 2010,108 post-hepatectomy patients with HCC associated with liver cirrhosis were enrolled in this prospective,non-randomized controlled study.The 54 postoperative patients in the treatment group received hydroxyethyl starch solution（HES130/0.4）treatment daily for the first three postoperative days;the other 54 postoperative patients in the control group were given intravenous albumin therapy.Preoperative and postoperative alanine aminotransferase,aspartate aminotransferase,albumin,C-reactive protein,the incidence of postoperative complications and postoperative length of stay were compared.Results Preoperative clinical data,type of liver resection and operative bleeding of the 2 groups were comparable（P0.05）.There was no significant difference in alanine aminotransferase,aspartate aminotransferase,albumin and the incidence of postoperative complications between the two groups.Compared with the control group,the C-reactive protein level on the second day after surgery was significantly lower in the treatment group（t=6.351,P=0.000）,and the C-reactive protein level on day 4 and day 7 after surgery also declined,but not significantly（P0.05）.The postoperative complications included infection of incisional wound,pleural effusion,ascites,pulmonary infection,abdominal bleeding,bile fistula and abdominal infection.In the control group,39 patients had one or more of the complications mentioned above（72.2%,39/54）,and in the treatment group,only 28 patients developed complications（51.9%,28/54）.the incidence of postoperative complications was significant difference between the 2 groups（χ2=4.757,P=0.047）.Conclusions Hydroxyethyl starch solution（HES130/0.4）treatment in the early period after hepatectomy for HCC associated with liver cirrhosis can effectively obviate the use of albumin,control postoperative inflammation and reduce the perioperative incidence of complications.