Child-Pugh A级肝癌患者癌旁肝组织病理改变与术后肝功能衰竭发生的相关性分析

Correlation between pathological changes of pericancer tissues and posthepatectomy liver failure for hepatocellular carcinoma in patients with Child-Pugh A

目的探讨Child-Pugh A级肝癌患者癌旁肝组织病理改变与术后肝功能衰竭发生的相关性。方法回顾性分析93例于该院行肝癌根治术的Child-Pugh A级患者癌旁肝组织的病理改变与术后肝功能衰竭发生的相关性及其与术前、术后主要的血清肝功能生化指标的相关性。结果 93例中有18例术后发生肝衰竭,该组病例癌旁肝组织的各项病理学指标以及Knodell总分均与非肝衰竭组间存在统计学差异(P<0.001);术前血清前白蛋白、γ谷氨转肽酶(γ-GT)及碱性磷酸酶(ALP)的表达量在肝衰竭与非肝衰竭组间存在统计学差异(P值分别为0.010、0.000、0.002);癌旁肝组织Knodell总分与术前前白蛋白、γ-GT、ALP相关(P值分别为0.011、0.001、0.026),与术后第7天γ-GT及ALP相关(P值分别为0.004、0.015)。结论Child-Pugh A级肝癌患者癌旁肝组织的病理学损害程度以及术前血清γ-GT、ALP高表达和前白蛋白低表达均与术后肝功能衰竭的发生密切相关。

Objective To explore the correlation between pathological changes of pericancer tissues and posthepatectomy liver failure for hepatocellular carcinoma in the patients with Child-Pugh A. Methods The data of93 patients with Child-Pugh A who underwent liver resection for HCC in our hospital were retrospectively analyzed.The correlation between pathological changes of pericancer tissues and posthepatectomy liver failure and its correlation with serum liver biochemical indexes of preoperation and postoperation were evaluated. Results There were significant differences in the pathological indicators and Knodell scores of pericancer tissues between 18 patients with liver failure and the other patients with no liver failure（ P 0. 001）,and there were significant differences in the levels of preoperative serum prealbumin,γ-GT and ALP between the patients with liver failure and those with no liver failure（ P = 0. 010,0. 000,0. 002）. The Knodell scores of pericancer tissues and preoperative serum prealbumin,γ-GT and ALP were correlated（ P = 0. 011,0. 001,0. 026） and they were also correlated with the serum γ-GT and ALP 7days after the operation（ P = 0. 004,0. 015）. Conclusion The degree of pathological damage in pericancer tissues,the high levels of preoperative serum γ-GT and ALP and the low level of prealbumin are closely correlated with the liver failure after hepatectomy.