Influence of portal hypertension on postoperative complications after hepatectomy for hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2016.01.009

Abstract

Abstract:

Objective

To investigate the influence of portal hypertension (PHT) on the postoperative complications after hepatectomy for patients with hepatocellular carcinoma (HCC).

Methods

Clinical data of 152 HCC patients undergoing hepatectomy in Sun Yat-sen University Cancer Center from March 2003 to October 2005 were retrospectively analyzed. The patients were divided into the PHT and non-PHT groups. There were 76 patients in the PHT group including 62 males and 14 females, with a mean age of (49±11) years. There were 76 patients in the non-PHT group including 66 males and 10 females, with a mean age of (49±12) years. The informed consents of all patients were obtained and the local ethical committee approval had been received. After hospitalization, all patients received routine examination. The incidence of postoperative complications in two groups was observed and the independent risk factors for postoperative complications were evaluated. Normally distributed data were compared using t test. Non-normally distributed data were compared using Z test. The comparison of rate was conducted using Chi-square test. Independent risk factors for the incidence of postoperative complications were analyzed by Logistic multivariate regression test.

Results

The incidence of postoperative complications was 42% (32/76) and the liver function-related complications was 36% (27/76) in the PHT group, and were 20% (15/76), 16% (12/76) respectively in the non-PHT group, significant difference was observed between two groups (χ²=8.901, 7.760; P<0.05). No significant difference was observed in the percentage of patients with grade I-II complications between PHT group [75% (24/32)] and non-PHT group [73% (11/15)](χ²=0.015, P>0.05). No significant difference was observed in the 90-day mortality between PHT group [7% (5/76)] and non-PHT group [3% (2/76)] (χ²=0.599, P>0.05). Logistic regression analysis revealed that PHT complication (OR=3.376, 95%CI: 1.564-7.287, P<0.05) and number of tumors > 2 (OR=1.984, 95%CI: 1.248-3.154, P<0.05) were the independent risk factors for postoperative complications. PHT complication (OR=3.231, 95%CI: 1.431-7.298, P<0.05), number of tumors > 2 (OR=1.832, 95%CI: 1.137-2.952, P<0.05) and intraoperative transfusion > 400 ml (OR=2.776, 95%CI: 1.123-6.864, P<0.05) were the independent risk factors for liver function-related complications.

Conclusions

PHT can increase the incidences of postoperative complications and liver function-related complications after hepatectomy in HCC patients and is the independent risk factor for both complications. However, PHT will not increase the severity of postoperative complications or postoperative mortality.

Key words: Carcinoma, hepatocellular, Hypertension, portal, Postoperative complications

Miao Chen, Meixian Chen, Wei He, Kai Zhou, Qijiong Li, Jiliang Qiu, Yadi Liao, Binkui Li, Yunfei Yuan, Yun Zheng. Influence of portal hypertension on postoperative complications after hepatectomy for hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(01): 32-37.

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References 20

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参数	术后并发症		检验值	P值	肝功能相关并发症		检验值	P值
参数	无	有	检验值	P值	无	有	检验值	P值
ALT（U/L）	42（12~246）	40（20~118）	Z=-0.443	0.658	43（12~246）	40（20~118）	Z=-0.857	0.392
AST（U/L）	40（17~199）	47（18~117）	Z=-0.997	0.319	41（17~199）	48（21~117）	Z=-0.970	0.328
ALB（g/L）	42±4	41±4	t=0.962	0.338	42±4	42±4	t=0.458	0.648
TB（μmol/L）	15（6~47）	16（7~30）	Z=-0.243	0.808	15（6~47）	16（7~30）	Z=-1.086	0.277
PT（s）	14（10~19）	14（12~17）	Z=-2.525	0.012	14（10~19）	14（12~16）	Z=-2.024	0.043
APTT（s）	37（15~54）	39（26~48）	Z=-1.756	0.079	37（15~54）	39（26~48）	Z=-2.042	0.041
INR	1.0 （0.8~1.5）	1.1（0.9~1.5）	Z=-2.769	0.006	1.0（0.8~1.5）	1.1（0.9~1.4）	Z=-2.478	0.013
MELD评分	8（6~18）	8（6~12）	Z=-0.403	0.687	8（6~18）	8（6~12）	Z=-0.025	0.980
肿瘤直径（cm）	5（1~15）	5（2~15）	Z=-0.070	0.944	5（1~15）	7（2~15）	Z=-1.405	0.160

参数	术后并发症		检验值	P值	肝功能相关并发症		检验值	P值
参数	无	有	检验值	P值	无	有	检验值	P值
ALT（U/L）	42（12~246）	40（20~118）	Z=-0.443	0.658	43（12~246）	40（20~118）	Z=-0.857	0.392
AST（U/L）	40（17~199）	47（18~117）	Z=-0.997	0.319	41（17~199）	48（21~117）	Z=-0.970	0.328
ALB（g/L）	42±4	41±4	t=0.962	0.338	42±4	42±4	t=0.458	0.648
TB（μmol/L）	15（6~47）	16（7~30）	Z=-0.243	0.808	15（6~47）	16（7~30）	Z=-1.086	0.277
PT（s）	14（10~19）	14（12~17）	Z=-2.525	0.012	14（10~19）	14（12~16）	Z=-2.024	0.043
APTT（s）	37（15~54）	39（26~48）	Z=-1.756	0.079	37（15~54）	39（26~48）	Z=-2.042	0.041
INR	1.0 （0.8~1.5）	1.1（0.9~1.5）	Z=-2.769	0.006	1.0（0.8~1.5）	1.1（0.9~1.4）	Z=-2.478	0.013
MELD评分	8（6~18）	8（6~12）	Z=-0.403	0.687	8（6~18）	8（6~12）	Z=-0.025	0.980
肿瘤直径（cm）	5（1~15）	5（2~15）	Z=-0.070	0.944	5（1~15）	7（2~15）	Z=-1.405	0.160

参数		例数	术后并发症		χ ²值	P值	肝功能相关并发症		χ ²值	P值
参数		例数	例数	发生率	χ ²值	P值	例数	发生率	χ ²值	P值
年龄（岁）		?	?	?	2.220	0.136	?	?	0.402	0.526
?	≤65	140	41	29.3%	?	?	35	25.0%	?	?
?	> 65	12	6	50.0%	?	?	4	33.3%	?	?
性别		?	?	?	0.078	0.781	?	?	0.348	0.555
?	男	128	39	30.5%	?	?	34	26.6%	?	?
?	女	24	8	33.3%	?	?	5	20.8%	?	?
肝炎病毒类型		?	?	?	1.173	0.279	?	?	-	0.556
?	乙型病毒性肝炎	141	42	29.8%	?	?	37	26.2%	?	?
?	非乙型病毒性肝炎	11	5	45.5%	?	?	0	0	?	?
肝功能Child-Pugh分级		?	?	?	0.008	0.927	?	?	-	0.570
?	A级	149	46	30.9%	?	?	39	26.2%	?	?
?	B级	3	1	33.3%	?	?	0	0	?	?
门静脉高压症		?	?	?	8.901	0.003	?	?	7.760	0.005
?	无	76	15	19.7%	?	?	12	15.8%	?	?
?	有	76	32	42.1%	?	?	27	35.5%	?	?
肿瘤数量（个）		?	?	?	9.569	0.008	?	?	7.353	0.025
?	1	104	22	21.3%	?	?	20	19.2%	?	?
?	2	22	11	50.0%	?	?	8	36.4%	?	?
?	>2	26	12	46.2%	?	?	11	42.3%	?	?
肿瘤侵犯血管		?	?	?	0.607	0.436	?	?	0.631	0.427
?	无	134	52	38.9%	?	?	33	24.6%	?	?
?	有	18	5	29.9%	?	?	6	33.3%	?	?
肿瘤侵犯邻近组织		?	?	?	0.063	0.802	?	?	0.108	0.742
?	无	131	41	31.3%	?	?	33	25.2%	?	?
?	有	21	6	28.6%	?	?	6	28.6%	?	?
淋巴结转移		?	?	?	-	0.553	?	?	-	0.304
?	无	149	47	31.5%	?	?	39	26.2%	?	?
?	有	3	0	0	?	?	0	0	?	?
Pringle法阻断第一肝门		?	?	?	0.996	0.318	?	?	1.164	0.281
?	无	37	9	24.3%	?	?	7	18.9%	?	?
?	有	115	38	33.0%	?	?	32	27.8%	?	?
切除肝段数		?	?	?	1.430	0.489	?	?	1.490	0.475
?	1	75	20	26.7%	?	?	16	21.3%	?	?
?	2	49	18	36.7%	?	?	15	30.6%	?	?
?	>2	28	9	32.1%	?	?	8	28.6%	?	?
术中出血量（ml）		?	?	?	3.942	0.047	?	?	6.495	0.011
?	≤400	113	30	26.5%	?	?	23	20.4%	?	?
?	> 400	39	17	43.6%	?	?	16	41.0%	?	?
术中输血		?	?	?	3.697	0.055	?	?	5.409	0.020
?	无	121	33	27.3%	?	?	26	21.5%	?	?
?	有	31	14	45.2%	?	?	13	41.9%	?	?

参数		例数	术后并发症		χ ²值	P值	肝功能相关并发症		χ ²值	P值
参数		例数	例数	发生率	χ ²值	P值	例数	发生率	χ ²值	P值
年龄（岁）		?	?	?	2.220	0.136	?	?	0.402	0.526
?	≤65	140	41	29.3%	?	?	35	25.0%	?	?
?	> 65	12	6	50.0%	?	?	4	33.3%	?	?
性别		?	?	?	0.078	0.781	?	?	0.348	0.555
?	男	128	39	30.5%	?	?	34	26.6%	?	?
?	女	24	8	33.3%	?	?	5	20.8%	?	?
肝炎病毒类型		?	?	?	1.173	0.279	?	?	-	0.556
?	乙型病毒性肝炎	141	42	29.8%	?	?	37	26.2%	?	?
?	非乙型病毒性肝炎	11	5	45.5%	?	?	0	0	?	?
肝功能Child-Pugh分级		?	?	?	0.008	0.927	?	?	-	0.570
?	A级	149	46	30.9%	?	?	39	26.2%	?	?
?	B级	3	1	33.3%	?	?	0	0	?	?
门静脉高压症		?	?	?	8.901	0.003	?	?	7.760	0.005
?	无	76	15	19.7%	?	?	12	15.8%	?	?
?	有	76	32	42.1%	?	?	27	35.5%	?	?
肿瘤数量（个）		?	?	?	9.569	0.008	?	?	7.353	0.025
?	1	104	22	21.3%	?	?	20	19.2%	?	?
?	2	22	11	50.0%	?	?	8	36.4%	?	?
?	>2	26	12	46.2%	?	?	11	42.3%	?	?
肿瘤侵犯血管		?	?	?	0.607	0.436	?	?	0.631	0.427
?	无	134	52	38.9%	?	?	33	24.6%	?	?
?	有	18	5	29.9%	?	?	6	33.3%	?	?
肿瘤侵犯邻近组织		?	?	?	0.063	0.802	?	?	0.108	0.742
?	无	131	41	31.3%	?	?	33	25.2%	?	?
?	有	21	6	28.6%	?	?	6	28.6%	?	?
淋巴结转移		?	?	?	-	0.553	?	?	-	0.304
?	无	149	47	31.5%	?	?	39	26.2%	?	?
?	有	3	0	0	?	?	0	0	?	?
Pringle法阻断第一肝门		?	?	?	0.996	0.318	?	?	1.164	0.281
?	无	37	9	24.3%	?	?	7	18.9%	?	?
?	有	115	38	33.0%	?	?	32	27.8%	?	?
切除肝段数		?	?	?	1.430	0.489	?	?	1.490	0.475
?	1	75	20	26.7%	?	?	16	21.3%	?	?
?	2	49	18	36.7%	?	?	15	30.6%	?	?
?	>2	28	9	32.1%	?	?	8	28.6%	?	?
术中出血量（ml）		?	?	?	3.942	0.047	?	?	6.495	0.011
?	≤400	113	30	26.5%	?	?	23	20.4%	?	?
?	> 400	39	17	43.6%	?	?	16	41.0%	?	?
术中输血		?	?	?	3.697	0.055	?	?	5.409	0.020
?	无	121	33	27.3%	?	?	26	21.5%	?	?
?	有	31	14	45.2%	?	?	13	41.9%	?	?

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