脂肪肝合并肝癌患者接受根治术后的临床疗效与安全性分析

Clinical efficacy and safety analysis of patients with fatty liver combined with hepatocellular carcinoma after radical surgery

目的探讨脂肪肝合并肝癌患者接受根治术后的临床疗效与安全性。方法选取2012年1月~2016年1月在我院诊治的脂肪肝合并肝癌患者64例进行前瞻性研究,根据脂肪浸润肝脏细胞的程度分为轻度脂肪变性组(32例)和中重度脂肪变性组(32例),另选取同期诊治的未合并脂肪变性的肝癌患者30例作为对照组,比较三组患者的术中指标(手术时间、术中出血量及肝门阻断时间)、术后指标(重症监护室监护时间和住院时间)及术后并发症。结果与对照组和轻度脂肪变性组相比,中重度脂肪变性组患者的手术时间显著延长,术中出血量显著增加,差异均有统计学意义(P<0.05);而对照组与轻度脂肪变性组相比,差异均无统计学意义(P>0.05);与对照组和轻度脂肪变性组相比,中重度脂肪变性组患者的ICU监护时间及住院时间均显著延长,差异具有统计学意义(P<0.05);与对照组相比,中重度脂肪变性组患者0级并发症的发生率显著降低(P<0.05);与对照组和轻度脂肪变性组相比,中重度脂肪变性组3~5级并发症的发生率显著增加,差异有统计学意义(P<0.05)。结论轻度脂肪肝合并肝癌患者接受根治术后其临床疗效较好,且安全性较高,而中重度脂肪肝会提高风险性。

Objective To investigate the clinical efficacy and safety of patients with fatty liver combined with hepato- cellular carcinoma after radical surgery. Methods A total of 64 patients with fatty liver complicated with hepatocellular carcinoma in our hospital from January 2012 to January 2016 were prospectively studied. The patients were divided into mild steatosis group （n=32）and moderate to severe steatosis group（n=32）, according to the degree of fat infiltra- tion of liver cells. 30 liver cancer patients with non-combined steatosis in the same period were selected as the control group. The intraoperative indexes（operation time, intraoperative blood loss and hepatic portal occlusion time）, postoper- ative indexes（intensive care unit monitoring time and hospital stay）and postoperative complications were compared be- tween the three groups. Results The operation time of the patients in the moderate to severe steatosis group was signifi- cantly longer than that of the control group and the mild steatosis group. And the intraoperative blood loss in the mod-erate to severe steatosis group was significantly increased, compared with that of the mild steatosis group, and the dif-ferences were statistically significant（P〈0.05）. While there were no significant differences in the operation time and the intraoperative blood loss between the control group and the mild steatosis group（P〉0.05）. The ICU monitoring time and hospitalization time of the patients in the moderate to severe steatosis group were significantly longer than those in the control group and the mild steatosis group, and the difference was significant（P〈0.05）. The incidence of grade 0 com- plication was significantly lower in the moderate to severe steatosis group than that in the control group（P〈0.05）. The incidence of grade 3-5 complication in the moderate to severe steatosis group was significantly increased, compared with that of the control group and mild steatosis group（P〈0.05）. Conclusion The treatment of mild fatty liver combined with hepatocellular carcinoma in patients with mild fatty liver combined with hepatocellular carcinoma has good clinical curative effect, with high safety, while moderate to severe fatty liver will improve the risk.