血糖水平对肝癌腹腔镜术后复发的影响

Impact of blood glucose level on recurrence of liver cancer after laparoscopic surgery

目的探究血糖水平对肝癌腹腔镜术后复发的影响。方法回顾性分析2012年1月-2015年1月该院收治的98例原发性肝癌患者的临床资料,所有患者均经腹腔镜肝癌根治性切除术治疗。依据患者术后空腹血糖是否≥6.1 mmol/L将其分为血糖升高组(n=23)和对照组(n=75)。比较两组患者术后1年和2年肝癌复发情况,单因素和多因素分析肝癌腹腔镜术后复发的影响因素。结果血糖升高组和对照组患者术后1年复发率分别为47.82%和21.33%,术后2年复发率分别为73.91%和36.00%,血糖升高组患者术后1年和2年肝癌复发率均高于对照组,差异具有统计学意义(P<0.05)。Logistic多因素分析结果显示,空腹血糖高、Child-Pugh分级为B级、术中输血量多、存在淋巴管浸润、临床病理分期高、术后甲胎蛋白(AFP)高和无术后辅助治疗为肝癌腹腔镜术后复发的危险因素(P<0.05)。结论肝癌腹腔镜术后血糖升高的患者术后2年内复发率较高,且空腹血糖高、Child-Pugh分级为B级、术中输血量多、存在淋巴管浸润、临床病理分期高、术后AFP高、无术后辅助治疗为其术后复发的危险因素,应加强对高危患者的监控,降低术后复发率。

Objective To investigate the impact of blood glucose level on the recurrence of liver cancer afterlaparoscopic surgery.Methods The clinical data of98patients with primary hepatocellular carcinoma from January2012to January2015were retrospectively analyzed.All patients were treated by laparoscopic radical resectionof hepatocellular carcinoma.Patients were divided into elevated blood glucose group(n=23)and control group(n=75)according to whether the fasting blood glucose was≥6.1mmol/L.The recurrence of liver cancer in1yearand2years after operation was compared.The factors influencing the recurrence of liver cancer were analyzedby univariate and multivariate analysis.Results The recurrence rates were47.82%and21.33%respectively inthe patients with elevated blood glucose and the control group.The recurrence rates were73.91%and36.00%respectively in the2-year postoperative patients with blood glucose and1year and2years.The recurrence rate washigher than that of the control group,the difference was statistically significant(P<0.05).Logistic multivariateanalysis showed that fasting blood glucose was high,Child-Pugh grade B,intraoperative blood transfusion,lymphaticinvasion,high clinical pathology stage,postoperative alpha-fetoprotein(AFP)high,no postoperative adjuvant therapy(P<0.05).Conclusion The recurrence rate of patients with elevated liver cancer after laparoscopic surgery is high,and fasting blood glucose is high,Child-Pugh grade is B grade,blood transfusion is high,there is lymphatic invasion,high clinical pathology stage after AFP high,no postoperative adjuvant therapy for its postoperative recurrence of riskfactors,should strengthen the monitoring of high-risk patients,reduce postoperative recurrence rate.