经腹腔镜行肝切除术的肝脏恶性肿瘤患者手术并发症的危险因素及预测价值分析

Analysis of risk factors and predictive value of surgical complications in patients underwent laparoscopic hepatectomy for hepatic malignancy

目的对经腹腔镜行肝切除术的肝脏恶性肿瘤患者手术并发症的危险因素进行分析,并探讨相关因素对术后并发症发生的预测价值。方法以2015年10月-2018年12月于该院住院行手术治疗的56例肝脏恶性肿瘤患者作为研究对象,采用Fibrotouch测定患者的肝硬度值(LSM),并收集患者的相关临床资料,根据是否发生术后并发症进行分组比较,对可能影响术后并发症的相关因素进行多因素分析,同时绘制受试者工作特征曲线(ROC),对LSM在预测术后并发症方面的价值进一步分析。结果单因素分析显示,术前LSM、吲哚菁绿15 min滞留率(ICG R15)、术中出血量以及肝纤维化Ishake评分是患者术后并发症发生的影响因素(P<0.05);多因素Logistic回归分析显示,术前LSM和术中出血量2个变量被保留入回归方程(P<0.05,OR^>1),提示其为术后并发症发生的显著影响因素;ROC分析显示,当术前LSM为24 kPa、术中出血量大于350 ml时,预测术后并发症发生的敏感性和特异性最佳,ROC曲线下面积(AUC)分别为0.794和0.719。若联合术中出血量指标进行预测诊断,其诊断效能还能有明显地提高。结论术前LSM对预测肝脏恶性肿瘤患者行腹腔镜下肝切除术后并发症的发生具有较高的预测价值,且联合术中出血量预测价值更高。

Objective To analyze the risk factors of surgical complications in patients underwent laparoscopic hepatectomy for hepatic malignancy,and explore the predictive value of relevant factors for postoperative complications.Method 56 patients with malignant liver tumors were selected and treated with laparoscopic surgery from October 2015 to December 2018.All the patients were given Fibrotouch to determine the patient’s liver hardness value,and collect relevant clinical data of patients,then according to whether occured postoperative complications grouped and compared.Multivariate analysis was performed on the factors that might influence postoperative complications.Meanwhile,the value of ROC curve in predicting postoperative complications was draw and make further analysis.Results The results of univariate analysis showed that LSM,ICG R15,intraoperative blood loss and Ishake score of liver fibrosis were influential factors(P<0.05).Multivariate Logistic regression results showed two variables of LSM and intraoperative blood loss were retained in the regression equation(P<0.05,OR^>1),indicating that they were significant influencing factors for postoperative complications.According to ROC analysis,when the LSM was 24 kPa and the intraoperative blood loss was 350 ml,the sensitivity and specificity to predict postoperative complications were the best,and the ROC-AUC were respectively 0.794 and 0.719.If combined with hemorrhage index for predictive diagnosis,the diagnostic efficiency can be significantly improved.Conclusion LSM had a higher predictive value in predicting the occurrence of complications after laparoscopic hepatectomy in patients with liver malignancy,and the combined intraoperative blood loss has a higher predictive value.