肝硬化肝细胞癌术后标准残肝体积与肝功能代偿不全的相关性

Correlation between standard remnant liver volume and liver function decompensation in patients after surgery for hepatocellular carcinoma

目的:探讨肝硬化肝细胞癌术后标准残肝体积与肝功能代偿不全的相关性.方法:回顾性分析我院2009-08/2012-08收治的80例肝硬化肝细胞癌患者的资料,根据术后残肝比率的大小分为少量切除组(SR组)与大量切除组(LR组),分析比较两组患者手术前后肝功能指标、肿瘤标志物及术后转归情况.结果:两组患者术后总胆红素(total bilirubin,T B)、国际标准化比值(i n t e r n a t i o n a l normalized ratio,INR)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)均较术前大幅升高,并随时间推移而降低,差异具有统计学意义(P<0.05);LR组TB、INR、AST于术后均高于SR组,且ALT在术后第5、7天显著高于SR组,差异具有统计学意义(P<0.05);两组患者术后甲胎蛋白(α-fetoprotein,AFP)、CA19-9较术前均显著下降,差异具有统计学意义(P<0.05);LR组AFP于术后均高于SR组,差异具有统计学意义(P<0.05);LR组术后肝功能失代偿发生率及肝功能衰竭发生率高于SR组,差异具有统计学意义(25.0%vs 3.3%,12.0%vs 0%,均P<0.05),LR组患者的切口感染、门脉血栓、腹腔内出血的发生率虽与SR组并没有统计学差异,但仍可见其较SR组高.结论:标准残肝体积是反映肝硬化肝细胞癌患者术后肝贮备功能的一项良好的指标,标准残肝体积高的患者肝功能代偿不全及肝功能衰竭发生率较低.

AIM： To investigate the correlation between standard remnant liver volume and liver function decompensation in patients after surgery for hepatocellular carcinoma. METHODS： A total of 80 cases of hepatocellular carcinoma in patients with cirrhosis were retrospectively analyzed. According to the ratio of the size of the remnant liver volume after resection,patients were divided into two groups： a small resection（SR） group and a large resection（LR）group. The liver function, tumor markers and postoperative outcome of these two groups were compared before and after the surgery. RESULTS： The total bilirubin（TB）, international normalized ratio（INR）, alanine aminotransferase（ALT）, and aspartate aminotransferase（AST） increased significantly after surgery（P ＆lt; 0.05）. Postoperative TB, INR, AST in the LR group were higher than those in the SR group, and ALT on days 5 and 7 was significantly higher in the LR group than in the SR group（P ＆lt; 0.05）. α-fetoprotein（AFP） and CA19-9 significantly decreased after surgery（P ＆lt; 0.05）. Postoperative AFP in the LR group was significantly higher than that in the SR group（P ＆lt; 0.05）. The incidence of hepatic decompensation and hepatic failure in the LR group was higher than that in the SR group（25.0% vs 3.3%, 12.0% vs 0%, P ＆lt; 0.05 for both）, although the incidence of wound infection, portal vein thrombosis and intra-abdominal hemorrhage did not differ between the two groups. CONCLUSION： Standard remnant liver volume is a good indicator of liver reserve function in patients with hepatocellular carcinoma after operation, and patients with greater standard remnant liver volume has a lower incidence of liver function decompensation and hepatic failure.