门静脉高压症对肝细胞癌切除术后并发症的影响

Influence of portal hypertension on postoperative complications after hepatectomy for hepatocellular carcinoma

目的探讨门静脉高压症对肝细胞癌（肝癌）切除术后并发症发生的影响。方法回顾性分析2003年3月至2005年10月在中山大学肿瘤医院行肝癌切除术的152例患者临床资料。根据有否合并门静脉高压症,将患者分为门静脉高压症组和非门静脉高压症组。其中门静脉高压症组76例,男62例,女14例;平均年龄（49±11）岁。非门静脉高压症组76例,男66例,女10例;平均年龄（49±12）岁。所有患者均签署知情同意书,符合医学伦理学规定。入院后患者接受常规检查,观察两组患者术后并发症发生情况,分析影响患者术后并发症发生的独立危险因素。两组正态分布资料比较采用t检验,非正态分布资料比较采用Z检验,率的比较采用χ~2检验。肝癌术后并发症发生的危险因素分析采用Logistic多因素回归分析。结果门静脉高压症组患者术后并发症发生率为42%（32/76）,其中肝功能相关并发症发生率为36%（27/76）;非门静脉高压症组为20%（15/76）,其中肝功能相关并发症发生率为16%（12/76）,差异有统计学意义（χ~2=8.901,7.760;P〈0.05）。Ⅰ~Ⅱ级并发症在门静脉高压症组占75%（24/32）,在非门静脉高压症组占73%（11/15）,差异无统计学意义（χ~2=0.015,P〉0.05）。门静脉高压症组患者术后90 d死亡率为7%（5/76）,非门静脉高压症组为3%（2/76）,差异无统计学意义（χ~2=0.599,P〉0.05）。Logistic多因素回归分析显示,合并门静脉高压症（OR=3.376,95%CI：1.564~7.287,P〈0.05）和肿瘤数量〉2个（OR=1.984,95%CI：1.248~3.154,P〈0.05）是肝癌切除术后并发症发生的独立危险因素。合并门静脉高压症（OR=3.231,95%CI：1.431~7.298,P〈0.05）、肿瘤数量〉2个（OR=1.832,95%CI：1.137~2.952,P〈0.05）和术中输血量〉400 ml（OR=2.776,95%CI：1.123~6.864,P〈0.05）是肝癌切除术后肝功能相关并发症发生的独立危险因素。结论门静脉高压症可增加肝癌切除术后并发症及肝功能相关并发症的发生率,且是两者发生的独立危险因素,但不增加术后并发症的严重程度和术后死亡率。

Objective To investigate the influence of portal hypertension（PHT） on the postoperative complications after hepatectomy for patients with hepatocellular carcinoma（HCC）. MethodsClinical data of 152 HCC patients undergoing hepatectomy in Sun Yat-sen University Cancer Center from March 2003 to October 2005 were retrospectively analyzed. The patients were divided into the PHT and non-PHT groups. There were 76 patients in the PHT group including 62 males and 14 females, with a mean age of（49±11） years. There were 76 patients in the non-PHT group including 66 males and 10 females, with a mean age of（49±12） years. The informed consents of all patients were obtained and the local ethical committee approval had been received. After hospitalization, all patients received routine examination. The incidence of postoperative complications in two groups was observed and the independent risk factors for postoperative complications were evaluated. Normally distributed data were compared using t test. Non-normally distributed data were compared using Z test. The comparison of rate was conducted using Chi-square test. Independent risk factors for the incidence of postoperative complications were analyzed by Logistic multivariate regression test. Results The incidence of postoperative complications was 42%（32/76） and the liver function-related complications was 36%（27/76） in the PHT group, and were 20%（15/76）, 16%（12/76） respectively in the non-PHT group, significant difference was observed between two groups（χ~2=8.901, 7.760; P〈0.05）. No significant difference was observed in the percentage of patients with grade I-II complications between PHT group [75%（24/32）] and non-PHT group [73%（11/15）]（χ~2=0.015, P〉0.05）. No significant difference was observed in the 90-day mortality between PHT group [7%（5/76）] and non-PHT group [3%（2/76）]（χ~2=0.599, P〉0.05）. Logistic regression analysis revealed that PHT complication（OR=3.376, 95%CI： 1.564-7.287, P〈0.05） and number of tumors 〉 2（OR=1.984, 95%CI： 1.248-3.154, P〈0.05） were the independent risk factors for postoperative complications. PHT complication（OR=3.231, 95%CI： 1.431-7.298, P〈0.05）, number of tumors 〉 2（OR=1.832, 95%CI： 1.137-2.952, P〈0.05） and intraoperative transfusion 〉 400 ml（OR=2.776, 95%CI： 1.123-6.864, P〈0.05） were the independent risk factors for liver function-related complications. Conclusions PHT can increase the incidences of postoperative complications and liver function-related complications after hepatectomy in HCC patients and is the independent risk factor for both complications. However, PHT will not increase the severity of postoperative complications or postoperative mortality.