肝硬化门静脉高压症合并原发性肝癌患者腹腔镜术后并发症危险因素分析

Risk factors for complications after laparoscopic surgery for primary liver cancer patients with cirrhotic portal hypertension

目的分析肝硬化门静脉高压症合并原发性肝癌腹腔镜同期联合手术并发症危险因素,为完善围手术期并发症预防护理提供参考。方法回顾分析105例患者临床资料,记录手术并发症发生情况,采用单因素分析与logistic回归分析手术并发症独立危险因素。结果手术并发症总体发生率为68.57%。肺部感染、门静脉血栓和胸水发生率分别为25.71%、33.33%和28.57%。术前Child-Pugh分级、MELD评分、血红蛋白、术后卧床时间和腹腔引流管留置时间是总体手术并发症的危险因素(均P<0.05)。吸烟、术前MELD评分、术前腹水、手术方式、术后卧床时间和胃管留置时间是肺部感染的危险因素(均P<0.05)。术前Child-Pugh分级、血小板、术前腹水和手术方式是门静脉血栓的危险因素(均P<0.05)。年龄和术前MELD评分是术后胸水的危险因素(均P<0.05)。结论肝硬化门静脉高压症合并原发性肝癌腹腔镜同期联合手术面临较高的手术并发症风险,应针对危险因素加强专科护理,以降低手术并发症发生率。

Objective To analyze the risk factors for complications after laparoscopic surgery for primary liver cancer patients with cirrhotic portal hypertension,so as to provide references for improving perioperative management.Methods The clinical data of 105 patients were retrospectively analyzed,and their surgical complications were recorded.The independent risk factors of complications were analyzed using univariate analysis and logistic regression analysis.Results The overall incidence of surgical complications was 68.57%,with the incidence of pulmonary infection,portal vein thrombosis and pleural effusion of 25.71%,33.33%and 28.57%,respectively.The preoperative Child-Pugh grade,MELD score,hemoglobin concentration,postoperative bed-bound time and abdominal drainage tube indwelling time were risk factors for overall surgical complications(all P<0.05).Smoking,preoperative MELD score,preoperative ascites,surgical method,postoperative bed-bound time and gastric tube indwelling time were risk factors for pulmonary infection(all P<0.05).Moreover,the preoperative Child-Pugh grade,platelet level,preoperative ascites,and surgical method were risk factors for portal vein thrombosis(all P<0.05).Meanwhile,age and preoperative MELD score were risk factors for postoperative pleural effusion(both P<0.05).Conclusion Primary liver cancer patients with cirrhotic portal hypertension face high risks for their laparoscopic operation.Therefore,specialized nursing should be provided accordingly to reduce the incidence of surgical complications.