肝癌肝切除术后感染并发症相关危险因素的Meta分析

A meta-analysis of risk factors of postoperative infectious complications after liver resection for hepa- tocellular carcinoma

目的探讨肝癌肝切除术后感染并发症（PIC）发生的危险因素，为预测和预防术后感染的发生提供理论依据。方法检索PubMed、Embase、中国知网、维普和万方等数据库，收集1990年1月至2015年5月公开发表的有关肝切除PIC危险因素的相关文献，运用固定或随机模型对各个因素进行合并分析。结果共纳入14项研究、5841例肝癌手术切除患者。Meta分析结果显示术后感染组患者血清白蛋白水平低于术后非感染组（WMD=-1．80，95％CI：-2．79-0．80；P〈0．05）；合并糖尿病的患者术后感染率高于未合并糖尿病的患者（OR=1．94，95％CI：1．27—2．95；P〈0．05）；手术时间≤5h的患者术后感染率低于手术时间〉5h的患者（OR=0．31，95％CI：0．22～0．45；P〈0．05）；失血量≤2000ml的患者术后感染率低于失血量〉2000ml的患者（OR=0．30，95％CI：0．19—0．48；P〈0．05）；围手术期输血的患者术后感染率高于未输血的患者（OR=2．83，95％CI：2．04—3．93；P〈0．05）；术后发生胆漏的患者术后感染率高于无胆漏的患者（OR=3．79，95％CI：2．06—6．96；P〈0．05）。此外，首次手术的患者术后感染率高于再次手术的患者（OR=1．52，95％CI：0．99—2．33；P=0．05）；肿瘤直径≤5cm的患者术后感染率高于直径〉5cm的患者，但差异均无统计学意义（OR=1．09，95％C1：0．76～1．56；P〉0．05）。结论低白蛋白、合并糖尿病、手术时间〉5h、失血量〉2000ml、输血以及术后胆漏是肝切除术后感染的危险因素，而手术次数、肿瘤大小与PIC无相关性。

Objective To investigate the risk factors of postoperative infectious complications （PIC） after liver resection for hepatocellular carcinoma （HCC） using evidence based medicine to provide a basis for prediction and prevention of PIC. Methods The fixed-effects or random-effects model was per- formed on studies on risk factors of PIC in HCC patients published from January 1990 to May 2015 by searching the PubMed, Embase, CNKI, VIP and Wanfang Data. Results Fourteen studies involving HCC 5 841 patients were included in this meta-analysis. The level of serum albumin was significantly lower in the PIC group than the NPIC group （ WMD = - 1.80, 95% CI： - 2..79 - - 0. 80 ; P 〈 0. 05 ） ; Patients with dia- betes mellitus had a higher incidence of PIC than those withotrt diabetes mellitus （OR = 1.94, 95% CI： 1.27 - 2.95 ; P 〈 0.05 ） ; Patients with operation time less than 5 h had an decreased incidence of PIC than the other group （ OR = 0.31,95 % CI： 0.22 - 0.45 ; P 〈 0.05）. Patients with blood loss less than 2 000 ml had a lower incidenee of PIC than the other group （ OR = 0.30, 95% CI： 0. 19 - 0.48 ; P 〈 0.05 ）. Patients with blood transfusion had a higher incidence of PIC than those without transfusion （ OR = 2.83, 95% CI： 2. 04 - 3.93 ; P 〈 0.05 ）. Patients with postoperative bile leakage had a higher incidence of PIC than those without bile leakage （ OR = 3.79, 95% CI： 2. 06 - 6. 96 ; P 〈 0. 05 ）. Patients after primary hepatectomy had a higher incidence of PIC than those after repeat hepatectomy, but there was no significant difference be- tween the two groups （ OR = 1.52, 95% CI： 0. 99 ~ 2.33 ; P = 0.05 ）. Patients with tumor diameter less than 5 cm had a higher incidence of PIC than the other group, but there was no significant difference between the two groups （OR=I.09, 95% CI： 0.76 - 1.56; P〉0.05）. Conclusion A low level of serum albu- min, diabetes mellitus, operation time more than 5 h, blood loss more than 2 000 ml, blood transfusion, bile leakage were risk factors for the development of PIC.