原发性肝癌患者行解剖性肝切除术后大量腹水的危险因素分析

Analysis of risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma

目的探讨原发性肝癌患者行解剖性肝切除术后大量腹水的危险因素。方法选取2020年1月—2022年1月徐州医科大学附属医院肝胆胰外科收治的原发性肝癌患者80例,所有患者均行解剖性肝切除术,术后根据腹腔引流量分为大量腹水组和非大量腹水组。收集所有患者临床资料,经单因素和多因素Logistic回归分析原发性肝癌患者行解剖性肝切除术后发生大量腹水的危险因素。结果纳入的80例患者中,术后发生大量腹水18例,发生率为22.5%。单因素分析结果表明,术后发生大量腹水与前白蛋白水平、碱性磷酸酶水平、凝血酶原活动度、术前门静脉高压、吲哚菁绿15 min滞留率(ICGR15)、标准化剩余肝体积及术中出血量有关(P<0.05)。多因素Logistic回归分析结果表明,低前白蛋白水平、低凝血酶原活动度、术前门静脉高压和ICGR15>15%是导致原发性肝癌患者行解剖性肝切除术后发生大量腹水的独立危险因素(P<0.05)。结论低前白蛋白水平、低凝血酶原活动度、术前门静脉高压和ICGR15>15%是导致原发性肝癌患者行解剖性肝切除术后发生大量腹水的独立危险因素。

Objective To analysis the risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma.Methods A total of 80 primary hepatocellular carcinoma patients who were treated in Department of Hepatopancreatobiliary Surgery,the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2022 were selected and their clinical data were retrospectively analyzed.All patients performed anatomical hepatectomy and divided into two groups according to postoperative abdominal fluid drainage:a massive ascites group and a non-massive ascites group.The risk factors of massive ascites in primary hepatocellular carcinoma patients after anatomical hepatectomy were analyzed by univariate and multivariate logistic analyses.Results Among the 80 patients,there were 18 cases(22.5%)of massive ascites after anatomical hepatectomy.According to univariate analysis,postoperative massive ascites was related to prealbumin level,alkaline phosphatase level,prothrombin time activity,preoperative portal hypertension,indocyanine green retention rate at 15 min(ICGR15),standardized residual liver volume and intraoperative blood loss(P<0.05).Multivariate logistic analysis indicated that low prealbumin level,low prothrombin time activity,preoperative portal hypertension and ICGR15>15%were the independent risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma(P<0.05).Conclusions Low prealbumin level,low prothrombin time activity,preoperative portal hypertension and ICGR15>15%are the independent risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma.