HCC切除术后预测肝功能不全的风险模型分析

Risk prediction model of liver dysfunction after liver resection for HCC

目的 研究肝细胞肝癌(HCC)切除术后预测肝功能不全的危险因素。方法 回顾性分析2017年4月至2019年7月广安市人民医院收治的198例接受肝切除术治疗的HCC患者的临床资料。统计患者术前吲哚菁绿15min滞留率(ICG-R15)、血清白蛋白(Alb)等指标,分析术后肝功能不全发生情况,并采用多因素logistic回归分析HCC切除术后肝功能不全的独立影响因素。结果 98例患者均成功行肝切除术,术后有60例(30.30%)患者发生肝功能不全。多因素logistic回归分析显示,Alb(OR=1.752,95%CI=1.113~2.758)、ICG-R15(OR=1.136,95%CI=1.026~1.258)、肝门阻断时间(OR=1.129,95%CI=1.002~1.272)、肝切除量(OR=2.118,95%CI=1.070~4.192)、手术时间(OR=1.007,95%CI=1.001~1.013)是HCC切除术后肝功能不全的独立影响因素(P<0.05)。结论 HCC切除术后肝功能不全与术前ICG-R15增加、血清Alb水平下降、肝门阻断时间及手术时间延长、肝切除量增加有关。

Objective To study the risk factors for liver dysfunction after liver resection for hepatocellular carcinoma(HCC).Methods The clinical data of 198 HCC patients admitted to our hospital from April 2017 to July 2019 who received hepatectomy were retrospectively analyzed.The retention rate of indocyanine green at 15 minutes(ICG-R15),serum albumin(ALB)before surgery,and postoperative liver function were recorded.Multivariate logistic regression was used to analyze the independent risk factors for liver dysfunction after liver resection for HCC.Results All the 198 patients underwent hepatectomy successfully,and 60 patients(30.30%)had hepatic dysfunction after operation.Multivariate logistic regression analysis showed that ALB[odd ratio(OR)=1.752,95%confidence interval(CI)=1.113-2.758],ICG-R15(OR=1.136,95%CI=1.026-1.258),hepatic portal occlusion time(OR=1.129,95%CI=1.002-1.272),resected liver volume(OR=2.118,95%CI=1.070-4.192),and operation time(OR=1.007,95%CI=1.001-1.013)were independent risk factors for postoperative liver dysfunction(P<0.05).Conclusion Liver dysfunction after liver resection for HCC is associated with high preoperative ICG-R15,low serum ALB level,long time of hepatic portal occlusion and operation,and large resected liver volume.