原发性肝癌肝切除后发生肝功能衰竭的围术期相关危险因素

Risk factors of the perioperative liver failure after hepatectomy

目的探讨原发性肝癌肝切除后发生肝功能衰竭的围术期相关危险因素和防治。方法回顾性分析本院486例术后患者的临床资料,分析原发性肝癌肝切除后发生肝功能衰竭的围术期相关危险因素。结果术后发生肝功能衰竭74例,其发生率为15.23%。依据术后是否出现肝功能衰竭分为衰竭组和无衰竭组,分析两组患者的临床资料,并采用酶联免疫吸附测定法(ELISA)对患者术前和术后24 h血清白介素-6(IL-6)和肿瘤坏死因子(TNF-α)的变化进行测定分析。多因素回归分析显示,Child-Pugh分级和术中出血量为原发性肝癌肝切除后发生肝功能衰竭的独立相关因素(P<0.05)。术前和术后24 h肝功能衰竭组患者血清IL-6和TNF-α含量显著高于无衰竭组,肝功能衰竭组和无衰竭组术后24 h患者血清IL-6和TNF-α含量均较术前高,差异有统计学意义(P<0.05)。结论对患者围术期的积极保肝治疗,术中尽可能减少出血,对肝切除术后降低肝功能衰竭的发生有重要的临床意义。同时可采用相关炎性因子进行肝功能衰竭评估诊断。

Objective To investigate the risk factors of the perioperative liver failure after hepatectomy and to find the strategy to avoid it.Methods Clinical and pathological data of 486 cases of patients with hepatic cell carcinoma were collected.The perioperative risk factors in the patients with the complication were analyzed.Results Among 486 pa- tients with hepatectomy,74 patients （15.23%） occurred liver failure.The patients were divided into liver failure group and non-failure group based on whether postoperative liver failure,clinical data were analyzed in two groups,and serum interleukin-6 （IL-6） and tumor necrosis factor （TNF-ct） changes before and after 24 hours were measured and analyzed by enzyme-linked immunosorbent assay （ELISA）.The related regression analysis for liver failure revealed that the pa tients occurring complications after hepatectomy were significantly related to patients with Child-Pugh classification, blood loss （P〈0.05）.The serum IL-6 and TNF-ct of liver failure group were higher than those in non-failure group at preoperative and 24 h after operation.The serum IL-6 and TNF-ct of 24 h after operation were higher than those in preoperative in two groups.The differences were significant （P〈0.05）.Conclusion It is important that positive liver pro- tection therapy and less bleeding for reducing the occurrence of liver failure after hepatectomy.Related inflammation factors can be used to the assessment and diagnose of liver failure.