术中出血对早期肝细胞癌病人围术期及预后的影响

Intraoperative hemorrhage related to perioperative events and prognosis of patients with early stage hepatocellular carcinoma

目的:探讨早期肝细胞癌病人术中出血对病人围术期及预后的影响。方法:回顾性分析2008年1月至2013年12月天津医科大学肿瘤医院行手术切除的222例早期肝细胞癌病人。根据ROC曲线分析,术中出血量≤200 m L的185例为A组,而出血量>200 m L的37例为B组。比较两组有无腹水及感染等并发症发生、住院时间,以及生存时间。结果:两组间在性别、年龄、术前血小板计数、术前凝血酶原时间、术前血清总胆红素水平及肿瘤数和直径等方面无统计学差异(P>0.05)。与出血量>200 m L的B组病人作比较,出血量≤200 m L A组病人的中位生存时间较长,住院时间较短,腹水和感染的发生率较少,差异具有统计学意义(P<0.05)。结论:对于早期肝细胞癌病人,术中大出血可能对围术期并发症发生及远期预后产生不良影响。术中仔细操作,减少出血量非常必要。

Objective To explore intraoperative bleeding of patients with early stage hepatocellular carcinoma which may relate to perioperative events and the prognosis.Methods A retrospective analysis was performed on 222 patients with early stage hepatocellular carcinoma who underwent surgical resection in Tianjin Medical University Cancer Hospital from January 2008 to December 2013.According to the receiver operating characteristic curve analysis of the volume of intra-operative blood loss,185 cases with blood loss 200 m L or less were assigned into group A and 37 cases with blood loss more than 200 m L into group B.Hospital stay,complication and overall survival were compared between two groups.Results There were no significant difference in gender,age,preoperative platelet counting,prothrombin time and total serum bilirubin and diameter and number of tumor between two groups statistically（P〉0.05）.Longer median survival time of the patients,shorter hospital stay,less cases with ascites and infection were found in group A when compared those in group B（P〈0.05）.Conclusions For patients with early stage hepatocellular carcinoma,intraoperative bleeding may be a negative factor for the perioperative complications and long term survival.It is necessary to reduce the bleed-ing during hepatectomy.