术后短疗程糖皮质激素对原发性肝癌患者术后肝功能恢复的影响

Effect of short-term glucocorticoid therapy on liver function recovery in patients after hepatectomy for primary liver cancer

目的:探讨原发性肝癌术后短疗程应用糖皮质激素对患者术后肝功能恢复的影响及相关不良反应。方法:回顾性分析2014年1月—2015年8月126例原发性肝癌行开腹肝切除术治疗患者的临床资料,其中63例术后常规予以护肝、补充白蛋白等治疗(对照组),另63例在以上基础上术后当日起开始连续3 d静滴甲强龙80 mg/d,后减量至40 mg/d应用2 d后停药(激素治疗组)。比较两组患者术前及术后肝功能相关指标、肝功能不全发生情况、白蛋白用量、术后并发症发生情况与住院时间。结果:两组患者术前及术中相关资料均具有可比性(均P>0.05);两组术后白蛋白水平、转氨酶水平、术后白蛋白用量及住院时间差异均无统计学意义(均P>0.05);激素治疗组术后第2、3天总胆红素水平、肝功能不全发生率、术后总并发症发生率均明显低于对照组(19.0%vs.34.9%,27.0%vs.44.4%)(均P<0.05)。结论:原发性肝癌术后短疗程应用糖皮质激素有益于患者术后肝功能恢复,减少并发症的发生,且不会增加糖皮质相关不良反应。

Objective： To investigate the influence of short-term glucocorticoid therapy on liver function recovery in patients after hepatectomy for primary liver cancer and the associated adverse effects. Methods： The clinical data of 126 patients with primary liver cancer undergoing open hepatectomy during January 2014 to August 2015 were retrospectively analyzed. Of the patients, 63 cases received conventional postoperative management such as hepatoprotective treatment and albumin supplement （control group）, the other 63 cases received the conventional postoperative management plus intravenous infusion of methylprednisolone, 80 mg/d, for the first three postoperative days and then 40 mg/d for the next two days （glucocorticoid therapy group）. The pre- and postoperative liver function parameters, incidence of hepatic insufficiency, albumin usage and incidence of postoperative complications and length of hospital stay were compared between the two groups. Results： The preoperative and operative data were comparable between the two groups （all P〉0.05）. The serum levels of albumin and transaminases as well as postoperative albumin usage and length of postoperative hospital stay showed no significant difference between the two groups （all P〉0.05）, while, the total bilirubin level on postoperative day 2 and 3, incidence of hepatic insufficiency （19.0% vs. 34.9%） and overall incidence of postoperative complications （27.0% vs. 44.4%） in glucocorticoid treatment group were significantly lower than those in control group （all P〈0.05）. Conclusion： Short-term glucocorticoid treatment after hepatectomy for primary liver cancer is beneficial to liver function recovery and reducing complications of the patients, without increase of the glucocorticoid-related adverse effects.