解剖性肝切除术治疗原发性肝癌临床疗效及预后影响因素Logistic回归分析

Clinical Curative Effect of Anatomic Resection on Primary Liver Cancer and Logistic Regression Analysis of Prognostic Influencing Factors

目的:探讨解剖性肝切除术治疗原发性肝癌临床疗效及预后影响因素的Logistic回归分析。方法:2014年1月—2018年1月本院收治的258例PLC患者,随机数字表法将其分为解剖组和非解剖组各129例。解剖组接受解剖性肝切除术(AR)治疗,非解剖组接受非解剖性肝切除术(NAR)治疗。于两组患者术前、术后7 d时,测定,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)各肝功能指标,记录两组手术时间、术中出血量、术中输血量及住院时间;对患者随访2年,统计患者预后不良情况并收集可能导致解剖组患者预后不良的影响因素,采用多因素Logistic回归分析法分析预后影响因素。结果:术后7 d时,解剖组的血清AST、ALT及TBIL指标分别为(32.59±9.57)IU/L、(53.25±17.34)IU/L、(18.57±5.22)μmol/L,明显低于非解剖组的(62.75±20.96)IU/L、(105.46±34.81)IU/L、(21.44±6.83)μmol/L,差异有统计学意义(P<0.05);经统计,解剖组2年内预后不良率(34.1%)明显低于非解剖组(46.67%),差异有统计学意义(P<0.05)。解剖组的手术时间为(254.7±47.1)min,明显长于非解剖组的(175.6±31.4)min,术中出血量为(452.9±70.6)mL,术中输血量为(276.3±58.4)mL,住院时间为(13.3±2.6)d,明显小于非解剖组的(616.4±83.5)mL、(515.7±85.6)mL和(14.5±2.8)d(P<0.05)。Logistic回归分析结果显示,年龄>65岁、肿瘤大小>6 cm、门静脉浸润、合并肝硬化、合并乙型肝炎病毒(HBV)是影响患者预后的独立危险因素(P<0.05)。结论:AR治疗PLC疗效确切,能减少术中出血,缩短住院时间,年龄、肿瘤大小、门静脉浸润、肝硬化、HBV均对AR治疗PLC患者预后有影响。

Objective To explore the clinical curative effect of anatomic resection(AR)on primary liver cancer(PLC)and logistic regression analysis of prognostic influencing factors.Methods A total of 258 PLC patients who were admitted to the hospital between January 2014 and January 2018 were divided into anatomic group and non-anatomic group by random number table method,129 cases in each group.The anatomic group underwent AR,while non-anatomic group underwent non-anatomic resection(NAR).Before surgery and at the 7 th day after surgery,liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)]in both groups were detected.The operation time,intraoperative blood loss,intraoperative blood transfusion and hospitalization time in both groups were recorded.The patients were followed up for 2 years.The poor prognosis was statistically analyzed.The influencing factors that might cause poor prognosis in anatomic group were collected.The influencing factors of prognosis were analyzed by multivariate logistic regression analysis.Results At the 7 th day after surgery,serum AST,ALT and TBIL in anatomic group were(32.59±9.57)IU/L,(53.25±17.34)IU/L and(18.57±5.22)μmol/,which significantly lower than those in non-anatomic group[(62.75±20.96)IU/L,(105.46±34.81)IU/L,(21.44±6.83)μmol/L](P<0.05).According to statistics,poor prognosis rate within 2 years in anatomic group was significantly lower than that in non-anatomic group(34.1%vs 46.67%)(P<0.05).The operation time in anatomic group was significantly longer than that in non-anatomic group[(254.7±47.1)min vs(175.6±31.4)min],while intraoperative blood loss,intraoperative blood transfusion and hospitalization time were significantly less than those in non-anatomic group(452.9±70.6)mL,(276.3±58.4)mL,(13.3±2.6)d vs(616.4±83.5)mL,(515.7±85.6)mL,(14.5±2.8)d(P<0.05).The results of logistic regression analysis showed that age older than 65 years old,tumor size larger than 6 cm,portal vein infiltration,cirrhosis and hepatitis B virus(HBV)were independent risk factors of prognosis(P<0.05).Conclusion The curative effect of AR is significant on PLC,which can reduce intraoperative blood loss,shorten hospitalization time.There are effects of age,tumor size,portal vein infiltration,cirrhosis and HBV on prognosis of PLC patients undergoing AR.