肝细胞癌合并肝硬化患者肝切除术后标准残肝体积评估

Critical value of standard residual liver volume for hepatectomy in patients with hepatocellular carcinoma associated with cirrhosis

目的:对比分析肝细胞癌合并肝硬化患者肝切除术后标准残肝体积安全临界值及对患者术后肝功能衰竭的影响。方法:选取自2015年7月-2017年7月本院肝细胞癌合并肝硬化并接受手术治疗的患者158例为研究对象,分为肝功能衰竭组和无肝功能衰竭组,观察记录患者的肿瘤体积、肝脏总体积、切除体积、手术时间、出血量及血小板等指标。结果:肝功能衰竭组22例,无肝功能衰竭组136例。肝功能衰竭组患者血小板数量、总肝体积、残肝分数和标准残肝体积均小于无肝功能衰竭组患者,术前总胆红素浓度高于无肝功能衰竭组患者,差异有统计学意义(P<0.05);标准残肝体积和术前总胆红素是进行肝切除术后患者出现肝功能衰竭的危险因素(P<0.05);患者标准残肝体积安全临界值为340.38mL/m2。结论:肝细胞癌合并肝硬化患者肝切术标准残肝体积安全临界值为340.38 mL/m2,当标准残肝体积小于该临界值时,患者发生肝功能衰竭风险增加。

Objective: To comparative analysis on hepatocellular carcinoma associated with liver cirrhosis patients with liver residual standard residual liver safety threshold. Methods: 158 patients of hepatocellular carcinoma associated with cirrhosis who were admitted to our hospital from July 2015 to July 2017 were selected and were divided into two groups according to liver failure after operation. Observation and record the patient’s tumor volume, total liver volume, resection volume,operation time, blood loss and platelet and other indicators. Results: There were 22 patients in the liver failure group and 136 patients in liver non-failure group. The platelet count, total liver volume,residual liver fraction, and standard residual liver volume in patients with hepatic failure were all lower than those in patients without hepatic failure. The preoperative total bilirubin concentration were higher than those in non-hepatic failure group, and the difference were statistically significant(P<0.05);standard residual volume and preoperative total bilirubin were risk factors for hepatic failure after hepatectomy(P<0.05);standard residual hepatic volume safety margin was 340.38 mL/m2. Conclusion: The critical value of standard residual liver volume for hepatocellular carcinoma with liver cirrhosis patients is 340.38 mL/m2. When the standard residual liver volume is less than the critical value, the risk of liver failure increases.