原发性肝癌肝切除术后患者发生肝功能衰竭的围术期危险因素分析

Perioperative Risk Factors for Liver Failure after Hepatectomy of Primary Hepatic Carcinoma

目的探讨原发性肝癌肝切除术后患者发生肝功能衰竭的围术期危险因素。方法选择2007年1月—2012年1月我院收治的原发性肝癌肝切除术后患者318例,根据是否发生肝功能衰竭将患者分为肝功能衰竭组和无肝功能衰竭组,回顾性分析其临床资料,采用单因素分析和多因素分析肝功能衰竭的围术期危险因素。结果 318例原发性肝癌肝切除术后患者中发生肝功能衰竭104例,肝功能衰竭发生率为32.70%,其中2例患者死于肝功能衰竭,病死率为0.63%。两组患者的年龄、血小板计数、肝功能Child-Pugh分级、合并血管癌栓情况、合并基础疾病情况、术中出血量比较,差异均有统计学意义(P<0.05)。多项二元Logistic回归分析结果显示,肝功能Child-Pugh分级、合并血管癌栓、术中出血量对肝功能衰竭的影响有统计学意义(P<0.05)。结论肝功能Child-Pugh分级、合并血管癌栓及术中出血量是原发性肝癌肝切除术后患者发生肝功能衰竭的围术期危险因素。

Objective To investigate the perioperative risk factors for liver failure after hepatectomy of primary hepatic carcinoma （PHC）. Methods Clinical and pathological data of 318 PHC patients having undergone hepateetomy of PHC admit-ted into our hospital between January 2007 and January 2012 were collected. The subjects were divided into a liver failure group and a non - liver failure group. Univariate and multivariate analyses were used for data analysis. Results Among the 318 pa-tients having undergone hepatectomy, liver failure occurred in 104 patients （32. 70% ）, and liver failure - caused mortality was 0. 63% （2/318 ）. Significant differences were observed between the two groups in age, platelet count, Child-Pugh classifica-tion, combined vascular embolism, combined underlying diseases, and intraoperative bleeding amount （ P 〈 0. 05 ）. Binary Lo-gistic regression analysis results showed that Child - Pugh classification, combined vascular embolism, and intraoperative bleed-ing amount had significant impact on the liver failure （ P 〈 0. 05 ）. Conclusion Child - Pugh classification, combined vascular embolism, and intraoperative bleeding amount were independent risk factors for liver failure after hepateetomy of PHC.