肝硬化患者脾切除术后发生肝癌的危险因素分析

Risk factors for liver cancer after splenectomy in patients with cirrhosis

目的分析肝硬化患者脾切除术后发生肝癌的危险因素。方法回顾性分析2000年3月至2012年11月在陕西省人民医院和西安交通大学第一附属医院行脾切除术的乙型肝炎肝硬化门静脉高压症患者的临床资料,共纳入150例患者,其中男性114例,女性36例,年龄(44±10)岁。记录患者的一般资料、术中情况、术后并发症等临床资料。术后采用电话或门诊复诊方式对患者进行随访,依据随访期内是否发生肝癌,将所有患者分为两组:肝癌组(n=42)和非肝癌组(n=108)。多因素logistic回归分析脾切除术后发生肝癌的影响因素。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果与非肝癌组患者相比,肝癌组中合并高血压的人数、直接胆红素、凝血酶原时间、脾脏最大径和术后血栓形成发生率均增加,而术后长期行规律抗病毒治疗的人数和术后出血发生率均减少,差异均具有统计学意义(均P<0.05)。多因素logistic回归分析,结果显示,术前高血压(OR=6.310,95%CI:1.729~23.024,P=0.005)、脾脏最大径>12 cm(OR=5.338,95%CI:1.234~23.094,P=0.025)和术后血栓形成(OR=8.652,95%CI:2.700~27.729,P<0.001)的乙型肝炎肝硬化门静脉高压症患者,脾切除术后发生肝癌的风险高;术后长期规律抗病毒治疗(OR=0.143,95%CI:0.038~0.545,P=0.004)的患者,发生肝癌的风险低。肝癌组患者的累积生存率与非肝癌组患者的累积生存率差异无统计学意义(χ^(2)=1.74,P=0.187)。结论术前高血压、脾脏最大径>12 cm和术后血栓形成是乙型肝炎肝硬化门静脉高压症患者脾切除术后发生肝癌的独立危险因素,而术后长期规律抗病毒治疗是其保护因素。

ObjectiveTo investigate the risk factors for liver cancer after splenectomy in patients with cirrhosis.MethodsThe clinical data of 150 patients diagnosed with hepatitis B associated cirrhosis,portal hypertension,and hypersplenism who underwent splenectomy at Shaanxi Provincial People's Hospital and the First Affiliated Hospital of Xi'an Jiaotong University from March 2000 to November 2012 were retrospectively analyzed.There were a total of 150 patients included,114 males and 36 females,aged(44±10)years old.General information,intraoperative conditions,and postoperative complications of the patients were documented.The postoperative progress of patients was monitored by telephone or outpatient follow-up.Based on the follow-up results regarding liver cancer presence,all patients were categorized into two groups:liver cancer group(n=42)and non-liver cancer group(n=108).Multivariate analysis was employed to identify factors influencing the liver cancer occurrence after splenectomy.Kaplan-Meier survival analysis along with log-rank test was utilized to assess overall survival and survival rate comparison.ResultsCompared to the non-liver cancer group,the liver cancer group exhibited an increased prevalence of hypertension,direct bilirubin levels,prothrombin time,maximum spleen diameter,and postoperative thrombosis(all P<0.05).However,there was a significant reduction in the number of patients receiving long-term regular antiviral therapy and postoperative bleeding(all P<0.05).The multivariate analysis revealed that preoperative hypertension(OR=6.310,95%CI:1.729-23.024,P=0.005),spleen diameter exceeding 12 cm(OR=5.338,95%CI:1.234-23.094,P=0.025),and occurrence of postoperative thrombosis(OR=8.652,95%CI:2.700-27.729,P<0.001)in patients with hepatitis B-related liver cirrhosis and portal hypertension were associated with an increased risk of developing liver cancer following splenectomy.Patients who receive long-term regular antiviral treatment after surgery(OR=0.143,95%CI:0.038-0.545,P=0.004)have a lower risk of developing liver cancer.There was no statistically significant difference observed in the cumulative survival rate between the liver cancer group and the non-liver cancer group(χ^(2)=1.74,P=0.187).ConclusionPreoperative hypertension,spleen diameter exceeding 12 cm,and postoperative thrombosis are independent risk factors for liver cancer in patients with hepatitis B-related cirrhosis and portal hypertension after splenectomy.Additionally,postoperative long-term antiviral therapy serves as an independent protective factor.