老年肝癌患者肝动脉化疗栓塞术后肝功能代偿不全的危险因素Logistic分析

Influencing factors of hepatic insufficiency after transcatheter arterial chemoembolization in elderly patients with hepatocellular carcinoma

目的分析影响老年肝癌患者肝动脉化疗栓塞术(TACE)后肝功能代偿不全的因素,探讨预防老年肝癌患者TACE并发肝功能代偿不全措施。方法选取我院2015年1月~2019年12月行TACE术术后并发肝功能代偿不全老年肝癌患者46例设为观察组。另选择同期在我院行TACE手术治疗未出现肝功能代偿不全的老年肝癌患者50例设为对照组。对两组患者的临床资料进行收集整理,并采用单因素分析发分析可能影响TACE术后出现肝功能代偿不全的相关因素,对于明确有影响的相关因素纳入多因素Logistic系统行高危因素分析。根据相关因素及高危因素,探讨预防老年肝癌TACE手术患者预防术后肝功能代偿不全的措施。结果 (1)老年肝癌TACE患者术后并发肝功能代偿不全的单因素分析显示,性别、年龄、肝癌病理类型、合并肝硬化、吲哚氯清除实验(ICGR-15)、Child-Pugh评分、术前血浆白蛋白(ALB)水平、TACE治疗次数为影响患者术后并发肝功能代偿不全的相关因素;(2)多因素Logistic分析:巨块型肝细胞癌、合并肝硬化、ICGR-15≥10%、Child-Pugh评分>10分、术前ALB≤25g/L、TACE治疗次数>2次为老年肝癌TACE术后并发肝功能代偿不全的高危因素。结论老年肝癌行TACE手术治疗患者术后并发肝功能代偿不全的影响因素以患者术前肝损害严重程度相关指标为主,其次为行TACE治疗次数,故术前应对患者的身体状况、肝损伤情况全面评估,谨慎制定手术方案,尽可能提升患者术后肝功能恢复效果。

Objective To analyze the factors affecting the hepatic insufficiency after transcatheter arterial chemoembolization(TACE) in elderly patients with hepatocellular carcinoma(HCC), and to explore the measures to prevent the complication of TACE with hepatic insufficiency. Methods 46 elderly patients with hepatocellular carcinoma who underwent TACE from January 2015 to December 2019 were selected as observation group. Another 50 elderly patients with hepatocellular carcinoma who underwent TACE operation in our hospital at the same time without hepatic insufficiency were selected as the control group. The clinical data of the two groups were collected and sorted out, and the related factors that may affect the occurrence of liver dysfunction after TACE were analyzed by univariate analysis. The high-risk factors were included in the multivariate logistic system to identify the influential factors. According to the related factors and high risk factors, to explore the preventive measures of liver insufficiency in elderly patients undergoing TACE operation. Results(1) Univariate analysis showed that gender, age, pathological type of liver cancer, cirrhosis, ICGR-15, Child-Pugh score, preoperative plasma albumin(ALB) level and the number of times of TACE treatment were the related factors affecting the complication of liver dysfunction after TACE;(2) Multifactor L. Ogistic analysis: massive hepatocellular carcinoma, cirrhosis, ICGR-15(> 10%), Child-Pugh score(> 10), preoperative ALB(< 25 g/L) and TACE treatment times(> 2 times) were the high risk factors for liver dysfunction after TACE for elderly patients with hepatocellular carcinoma. Conclusion The main influencing factors of hepatic insufficiency after TACE for elderly patients with hepatocellular carcinoma are the severity of liver injury before operation, followed by the number of times of TACE treatment. Therefore, the patients’ physical condition and hepatic injury should be evaluated comprehensively before operation, and the operation plan should be carefully formulated to improve the recovery effect of liver function after operation as far as possible.