门脉高压症患者肝脏储备功能评估的临床研究

Preoperative Assessment of Hepatic Functional Reserve in Patients with Portal Hypertension Syndrome

目的 :探讨肝硬化门脉高压症患者术前肝脏储备功能的评估方法。方法 :用L ogistic多元回归法分析了 80例门脉高压症断流患者术后出现肝功能不全的相关因素 ,从中筛选与肝功不全关系最密切的危险因子。结果 :排除手术操作本身的影响后 ,术后发生肝功不全影响最大的因素依次为 :肝性脑病 ( ENC)、血浆吲哚氰绿潴留试验 ( ICGR15)及门静脉充血指数 ( PCI)等 ,而术前的血清总胆红素 ( TBIL)、白蛋白 ( A)、A/G比值、总胆汁酸( TBA)、透明质酸 ( HA)、凝血酶原时间 ( PT)、门静脉内径 ( dp)、门静脉流速 ( Vp)及门静脉流量 ( Qp)等因素 ,在多元回归中所占比例不大。结论 :综合分析术前患者临床指标和肝功能实验室检查有助于评价肝硬化患者肝储备功能 。

Objective: To study the method of evaluating hepatic functional reserve in patients with portal hypertension syndrome due to hepatitis B cirrhosis by multiple risk factors. Methods: 80 cirrhotic patients were divided into 2 groups according to their conditions one month after operation.The 14 risk factors which are closely related to liver dysfunction were evaluated. Univariate,multivariate logistic analysis and receiver operation characteristic curves (ROC) were employed. Results: It turned out that the factors influencing the onset of postoperative liver dysfunction were encephalopathy (ENC), indocyanine green retention(ICG)test and portal congestion index(PCI). Conclusion: Clinic factors should be considered to integrate with laboratorial factors to evaluate hepatic functional reserve, which can help surgeons to choose an appropriate treatment plan and to predict the risk of the surgical complications more accurately.