原发性肝癌肝切除术后预防性抗凝对术后并发症的影响

Effects of prophylactic anticoagulation on postoperative complications after hepatectomy for primary liver cancer

目的探究原发性肝癌(PLC)患者术后预防性抗凝治疗能否降低术后并发症的发生风险,并探讨术后并发症的影响因素。方法收集2019年2月至2021年5月在海军军医大学(第二军医大学)第三附属医院接受PLC肝切除手术治疗的495例患者的临床资料,根据术后是否进行预防性抗凝将患者分为抗凝组(287例,术后接受预防性低分子肝素抗凝治疗)和常规治疗组(208例)。对比两组患者术后并发症发生情况,并采用logistic回归模型分析并发症发生的影响因素。结果495例患者肝切除术后总体并发症发生率为30.7%(152/495),按照发生率由高到低依次为感染(9.1%,45/495)、急性呼吸窘迫综合征(ARDS;6.5%,32/495)、出血(6.3%,31/495)、肝切除术后肝功能衰竭(PHLF;6.1%,30/495)、静脉血栓栓塞症(VTE;2.8%,14/495)。抗凝组术后VTE、ARDS、PHLF发生率均低于常规治疗组[1.4%(4/287)vs 4.8%(10/208)、3.8%(11/287)vs 10.1%(21/208)、3.8%(11/287)vs 9.1%(19/208),均P<0.05],但两组间术后出血的发生率差异无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄、门静脉高压、肿瘤数量是VTE的独立危险因素,门静脉高压、术中出血、术中输血、术前降钙素原是PHLF的独立危险因素,腹水、术前胆红素是ARDS的独立危险因素,而术后预防性抗凝是VTE、ARDS的独立保护因素(均P<0.05)。结论PLC患者肝切除术后预防性抗凝可以降低VTE、PHLF、ARDS的发生风险,且不会增加术后出血风险。年龄、门静脉高压、肿瘤数量、术中出血、术中输血、腹水、术前降钙素原、术前胆红素是PLC患者肝切除术后并发症发生的危险因素。

Objective To investigate whether prophylactic anticoagulation therapy can reduce the risk of postoperative complications in patients with primary liver cancer(PLC)after hepatectomy,and to explore the influencing factors of postoperative complications.Methods The clinical data of 495 patients undergoing hepatectomy for PLC in The Third Affiliated Hospital of Naval Medical University(Second Military Medical University)from Feb.2019 to May 2021 were collected.The patients were divided into anticoagulation group(n=287,receiving prophylactic low-molecular-weight heparin after surgery)and conventional treatment group(n=208).The postoperative complications were compared between the 2 groups,and the influencing factors were analyzed using logistic regression model.Results The postoperative overall complication incidence of the 495 patients after hepatectomy was 30.7%(152/495),ranking as infection(9.1%,45/495),acute respiratory distress syndrome(ARDS;6.5%,32/495),bleeding(6.3%,31/495),post-hepatectomy liver failure(PHLF;6.1%,30/495),and venous thromboembolism(VTE;2.8%,14/495).The incidence rates of postoperative VTE,ARDS,and PHLF were significantly lower in the anticoagulation group than those in the conventional treatment group(1.4%[4/287]vs 4.8%[10/208],3.8%[11/287]vs 10.1%[21/208],and 3.8%[11/287]vs 9.1%[19/208];all P<0.05),but there was no significant difference in the incidence of postoperative bleeding between the 2 groups(P>0.05).Multivariate logistic regression analysis showed that age,portal hypertension,and tumor number were independent risk factors for postoperative VTE;portal hypertension,intraoperative blood loss,intraoperative blood transfusion,and preoperative procalcitonin(PCT)were independent risk factors for PHLF;ascites and preoperative bilirubin were independent risk factors for ARDS;and postoperative prophylactic anticoagulation was an independent protective factor for VTE and ARDS(all P<0.05).Conclusion Prophylactic anticoagulation can reduce the risks of VTE,PHLF,and ARDS in PLC patients after hepatectomy,without increasing the risk of postoperative bleeding.Age,portal hypertension,number of tumors,intraoperative blood loss,intraoperative blood transfusion,ascites,preoperative PCT,and preoperative bilirubin are risk factors for postoperative complications of PLC patients after hepatectomy.