大范围肝切除术后肝衰竭危险因素分析

doi:10.3877/cma.j.issn.2095-3232.2018.02.014

目的

探讨大范围肝切除术后肝衰竭危险因素。

方法

回顾性研究2008年1月至2017年2月中山大学孙逸仙纪念医院收治的293例大范围肝切除术患者临床资料。患者均签署知情同意书，符合医学伦理学规定。根据有否发生术后肝衰竭，将患者分成肝衰竭组和无肝衰竭组。其中肝衰竭组23例，男22例，女1例；平均年龄（53±12）岁。无肝衰竭组270例，男224例，女46例；年龄（49±12）岁。采用单因素分析和Logistic回归分析分析术后肝衰竭的危险因素。

结果

大范围肝切除术患者术后肝衰竭发生率7.8%（23/293）。多因素Logistic回归分析显示术前Plt、肝功能Child-Pugh分级、肿瘤直径、血管癌栓为术后发生肝衰竭的独立影响因素（OR=0.983，0.020，0.726，0.225；P<0.05)。

结论

术前肝功能Child-Pugh分级、Plt、肿瘤直径、血管癌栓为大范围肝切除术后肝衰竭的独立影响因素。

关键词: 肝肿瘤, 肝切除术, 肝功能衰竭, 危险因素

Objective

To explore the risk factors of hepatic failure after major hepatectomy.

Methods

Clinical data of 293 patients receiving major hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2008 and February 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to whether there was postoperative hepatic failure, the patients were divided into the hepatic failure group and non-hepatic failure group. There were 23 cases in the hepatic failure group, including 22 males and 1 female with the mean age of (53±12) years. There were 270 cases in non-hepatic failure group, including 224 males and 46 females with the age of (49±12) years. Single factor analysis and Logistic regression analysis were used to analyze the risk factors of postoperative hepatic failure.

Results

The incidence of hepatic failure after major hepatectomy was 7.8% (23/293). Multi-factor Logistic regression analysis showed that preoperative Plt, Child-Pugh classification of liver function, tumor diameter and vascular tumor thrombus were the independent influence factors of postoperative hepatic failure (OR=0.983, 0.020, 0.726, 0.225; P<0.05).

Conclusion

Preoperative Plt, Child-Pugh classification of liver function, tumor diameter and vascular tumor thrombus are the independent influence factors of hepatic failure after major hepatectomy.

Key words: Liver neoplasms, Hepatectomy, Liver failure, Risk factors

表1 肝衰竭组和无肝衰竭组大范围肝切除术患者临床资料比较

因素	肝衰竭组	无肝衰竭组	统计值	P值
性别（例，男/女）	22/1	224/46	χ²=2.534	0.111
年龄（岁，±s）	53±12	49±12	t=1.719	0.707
糖尿病（例，无/有）	18/5	237/33	χ²=1.701	0.192
HBV感染（例，无/有）	0/23	32/238	-	0.080
术前Plt[×10⁹/L，M(Q_R)]	151(58～328)	234(36～651)	Z=4.464	<0.010
术前肝功能Child-Pugh分级（例，A/B级）	16/7	267/3	χ²=3.060	<0.010
肿瘤直径[cm，M(Q_R)]	8(2～15)	10(2～35)	Z=2.026	0.043
肝切除范围（例，左半肝以上/右半肝以上）	7/16	112/158	χ²=1.072	0.300
手术方式（例，开放/腹腔镜）	20/3	219/51	χ²=0.171	0.679
术中出血量[ml，M(Q_R)]	2 026(100～10 000)	837(50～7 000)0	Z=2.122	0.034
术中输血量[ml，M(Q_R)]	1 430(0～6 400)	412(0～3 000)	Z=3.622	<0.010
血管癌栓（例，无/有）	8/15	161/109	χ²=5.360	0.021

表1 肝衰竭组和无肝衰竭组大范围肝切除术患者临床资料比较

因素	肝衰竭组	无肝衰竭组	统计值	P值
性别（例，男/女）	22/1	224/46	χ²=2.534	0.111
年龄（岁，±s）	53±12	49±12	t=1.719	0.707
糖尿病（例，无/有）	18/5	237/33	χ²=1.701	0.192
HBV感染（例，无/有）	0/23	32/238	-	0.080
术前Plt[×10⁹/L，M(Q_R)]	151(58～328)	234(36～651)	Z=4.464	<0.010
术前肝功能Child-Pugh分级（例，A/B级）	16/7	267/3	χ²=3.060	<0.010
肿瘤直径[cm，M(Q_R)]	8(2～15)	10(2～35)	Z=2.026	0.043
肝切除范围（例，左半肝以上/右半肝以上）	7/16	112/158	χ²=1.072	0.300
手术方式（例，开放/腹腔镜）	20/3	219/51	χ²=0.171	0.679
术中出血量[ml，M(Q_R)]	2 026(100～10 000)	837(50～7 000)0	Z=2.122	0.034
术中输血量[ml，M(Q_R)]	1 430(0～6 400)	412(0～3 000)	Z=3.622	<0.010
血管癌栓（例，无/有）	8/15	161/109	χ²=5.360	0.021

表2 大范围肝切除术后发生肝衰竭的多因素Logistic回归分析

因素	b	SE(b)	Waldχ²	P值	OR	95%CI
术前Plt	-0.017	0.005	10.635	0.001	0.983	0.973～0.993
术前肝功能Child-Pugh分级	-3.919	1.183	10.981	0.001	0.020	0.002～0.202
肿瘤直径	-0.320	0.108	8.684	0.003	0.726	0.587～0.899
术中出血量	0.000	0.000	1.062	0.303	1.000	1.000～1.001
术中输血量	0.001	0.001	3.134	0.077	1.001	1.000～1.002
血管癌栓	-1.491	0.640	5.423	0.020	0.225	0.064～0.790

表2 大范围肝切除术后发生肝衰竭的多因素Logistic回归分析

因素	b	SE(b)	Waldχ²	P值	OR	95%CI
术前Plt	-0.017	0.005	10.635	0.001	0.983	0.973～0.993
术前肝功能Child-Pugh分级	-3.919	1.183	10.981	0.001	0.020	0.002～0.202
肿瘤直径	-0.320	0.108	8.684	0.003	0.726	0.587～0.899
术中出血量	0.000	0.000	1.062	0.303	1.000	1.000～1.001
术中输血量	0.001	0.001	3.134	0.077	1.001	1.000～1.002
血管癌栓	-1.491	0.640	5.423	0.020	0.225	0.064～0.790

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Risk factors analysis of hepatic failure after major hepatectomy

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Risk factors analysis of hepatic failure after major hepatectomy