70岁以上肝癌患者肝切除术安全性分析

Clinical analysis on hepatectomy in ≥70 years patients with hepatocellular carcinoma

目的分析70岁以上老龄肝癌患者肝切除术资料并探讨其安全性。方法回顾性分析2014年1月至2016年1月南京医科大学附属淮安第一医院老年肝癌患者行肝切除术的资料。根据年龄将患者分为≥70岁组(n=68)和<70岁组(n=84),分析两组术前临床资料[乙型肝炎表面抗原(HBsAg)阳性率、合并症、实验室指标、吲哚菁绿(ICG)15 min滞留率、Child-Pugh肝功能分级、甲胎蛋白(AFP)异常比例、肿瘤病理情况]、选择腹腔镜肝切除比例、术中出血量、手术时间、术后并发症发生率和死亡率、术后重症监护室(ICU)入住率、术后住院时间等指标。组间比较采用独立样本t检验、卡方检验或确切概率法。结果≥70岁组与<70岁组比较,术前HBsAg阳性率、血红蛋白(Hb)水平均较低[29.4%vs 71.4%,(128.18±15.26)vs(138.57±16.67)g/L,P<0.05],高血压较多(38.2%vs 14.3%),差异均有统计学意义(P<0.05);两组选择腹腔镜肝切除比例、术中出血量、手术时间差异无统计学意义(P>0.05);≥70岁组术后心血管事件发生率(13.2%vs 2.4%)及术后ICU入住率(48.5%vs 17.9%)与<70岁组比较更高(P<0.05),但术后其他并发症、死亡率及术后住院时间等两组之间差异无统计学意义(P>0.05)。结论严格掌握适应证、重视围手术期处理,70岁以上肝癌患者行肝切除是可行的。

Objective To analyze the clinical data of the elderly undergoing hepatectomy and investigate the safety of the surgery. Methods Clinical data of the patients undergoing hepatectomy for hepatocellular carcinoma in our department from January 2014 to January 2016 were collected and retrospectively analyzed.According to their age,they were divided into the ≥70 years group（n=68） and 〈70 years group（n=84）.Their comorbidities,tumor differentiation,Child-Pugh classification,and pre-operative positive rate of hepatitis B surface antigen（HBsAg）, ratio of abnormal alpha fetoprotein（AFP）, other laboratory indices, and indocyanine green retention rate at 15 min（ICG 15 min）, as well as operation-related indices, such as, ratio of laparoscopic hepatectomy, operation time,blood loss during operation, postoperative ratio of intensive care unit（ICU）stay, length of postoperative hospital stay, inci-dences of postoperative complications,and postoperative mortality,were analyzed and compared between the 2 groups.The inter-group comparison was carried out with independent sample t test,Chi-square test or exact probability test.Results Compared with the 〈70 years group,the ≥70 years group had a significantly lower pre-operative positive rate of HBsAg（29.4% vs 71.4%）,lower level of hemoglobin[Hb,（128.18 ±15.26）vs（138.57 ±16.67）g/L], but higher ratio of hypertension（38.2% vs 14.3%）.There were no obvious differences in the ratio of laparoscopic hepatectomy, operation time, and peri-operative blood loss between the 2 groups （P〉0.05）.The incidences of post-operative cardiovascular events（13.2% vs 2.4%）and ratio of ICU stay（48.5% vs 17.9%） were notably higher in the ≥70 years group than in 〈70 years group（P〈0.05）,though no significances were found in postoperative complications,mortality and length of hospital stay between the 2 groups（P 〉0.05）.Conclusion It is feasible to perform hepatectomy in the ≥70 years patients with hepatocellular carcinoma after strict indication and careful perioperative management.