Risk factors, prevention and treatments for postoperative liver failure in patients with hepatic alveolar echinococcosis

doi:10.3877/cma.j.issn.2095-3232.2018.06.014

Abstract

Abstract:

Objective

To explore the risk factors, prevention and treatments for liver failure after hepatectomy for hepatic alveolar echinococcosis.

Methods

Clinical data of 117 patients with hepatic alveolar echinococcosis admitted to the Affiliated Hospital of Qinghai University from August 2016 to August 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 117 patients, 47 cases were male and 70 female, aged (36±13) years on average. According to whether liver failure occurred after operation, the patients were divided into liver failure group (n=28) and non-liver failure group (n=89). The risk factors of liver failure after hepatectomy were analyzed by univariate and multivariate logistic regression.

Results

The incidence of postoperative liver failure was 24% (28/117) and its mortality was 21% (6/28). 21 patients were classified as Child-Pugh grade A, 4 grade B and 3 grade C. Multivariate logistic regression analysis showed that Child-Pugh grading, complicated with primary liver diseases, AST, operation time, intraoperative blood loss and intraoperative blood transfusion were the independent factors affecting the occurrence of liver failure (OR=0.089, 7.412, 1.010, 7.926, 5.961, 11.341; P<0.05).

Conclusions

The risk of liver failure after hepatectomy is high in patients with hepatic alveolar echinococcosis. Child-Pugh liver function grading, complicated with primary liver diseases, AST, operation time, intraoperative blood loss and intraoperative blood transfusion are the independent factors for liver failure. Preoperative comprehensive assessment of liver function reserve, shortening the operation time, managing intraoperative bleeding and timely diagnosis and treatment after operation are important measures to prevent the postoperative liver failure.

Key words: Echinococcosis, hepatic, Hepatectomy, Liver failure, Risk factors

Xiaolei Xu, Zhixin Wang, Li Ren, Lichao Hou, Yang Dan Cai Rang, Ying Zhou, Haijiu Wang, Yong Deng, Haining Fan. Risk factors, prevention and treatments for postoperative liver failure in patients with hepatic alveolar echinococcosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(06): 490-494.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2018.06.014

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2018/V07/I06/490

Figures/Tables 2

References 21

[1]	王宇明, 李兰娟. 《肝衰竭诊治指南（2012年版）》治疗进展解读与探讨[J]. 中华临床感染病杂志, 2013, 6(2):77-80.
[2]	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2015版)[J]. 中华消化外科杂志, 2015, 14(4):253-264.
[3]	Narita M, Oussoultzoglou E, Bachellier P, et al. Post-hepatectomy liver failure in patients with colorectal liver metastases[J]. Surg Today, 2015, 45(10):1218-1226.
[4]	李牧其, 周杰, 戴敏. 肝癌患者术前HBV-DNA与肝切除术后肝功能延迟恢复的相关性[J]. 中华肝胆外科杂志, 2015, 21(4):271-272.
[5]	刘朝辉, 杜振双, 林建泉, 等. 原发性肝癌肝切除术后发生肝功能衰竭的围术期影响因素分析[J]. 肝胆外科杂志, 2016, 24(5):375-377.
[6]	余昆, 熊伟, 李云峰, 等. 肝尾状叶肿瘤的手术治疗（附50例报告）[J]. 山东医药, 2012, 52(18):54-55.
[7]	吴健雄, 王黎明, 刘立国, 等. 肝区域血流选择性适时阻断在肝中央型大肿瘤切除中的应用[J]. 中华肿瘤杂志, 2012, 34(11):850-854.
[8]	陈绪涛, 翟健, 张一军, 等. Child-Pugh A级肝细胞癌患者术后肝功能衰竭发生的危险因素分析[J]. 肝胆外科杂志, 2012, 20(3):170-173.
[9]	Kim HJ, Kim CY, Park EK, et al. Volumetric analysis and indocyanine green retention rate at 15 min as predictors of post-hepatectomy liver failure[J]. HPB, 2015, 17(2):159-167.
[10]	许显志, 刘进忠, 李志锋, 等. 原发性肝癌肝切除术后发生肝功能衰竭的影响因素分析[J]. 现代仪器与医疗, 2017, 23(4):31-33.
[11]	邹周平, 单人锋, 万仁华, 等. 肝脏体积测定在肝癌肝切除术中的临床应用[J]. 南昌大学学报（医学版）, 2011, 51(9):23-25.
[12]	Massimino KP, Kolbeck KJ, Enestvedt CK, et al. Safety and efficacy of preoperative right portal vein embolization in patients at risk for postoperative liver failure following major right hepatectomy[J]. HPB, 2012, 14(1):14-19.
[13]	Chen JS, Huang JQ, Chen XL, et al. Risk factors associated with intraoperative major blood loss during resection of hepatocellular carcinoma[J]. Hepatogastroenterology, 2015, 62(140):790-793.
[14]	韩宽怀, 邱胜春, 凌光文, 等. 选择性入出肝血流阻断在肝切除术中的临床应用[J]. 西部医学, 2010, 22(9):1638-1639.
[15]	Okabe H, Beppu T, Chikamoto A, et al. Remnant liver volume-based predictors of postoperative liver dysfunction after hepatectomy: analysis of 625 consecutive patients from a single institution[J]. Int J Clin Oncol, 2014, 19(4):614-621.
[16]	Mizuguchi T, Kawamoto M, Meguro M, et al. Serum antithrombin Ⅲ level is well correlated with multiple indicators for assessment of liver function and diagnostic accuracy for predicting postoperative liver failure in hepatocellular carcinoma patients[J]. Hepatogastroenterology, 2012, 59(114):551-557.
[17]	窦科峰, 季茹. 原发性肝癌切除术后肝功能衰竭的防治[J]. 中华外科杂志, 2010, 48(20):1524-1526.
[18]	王桂林, 梅铭惠, 席江伟. 标准残肝体积在肝硬化肝脏功能储备评估的应用[J]. 中华肝胆外科杂志, 2013, 19(1):15-18.
[19]	冯志强, 肖梅, 张洪义, 等. 原发性肝癌规则与非规则性肝切除术式探讨[J]. 中国实用外科杂志, 2012, 32(3):226-228.
[20]	Kita S, Yasuchika K, Ishii T, et al. The protective effect of transplanted liver cells into the mesentery on the rescue of acute liver failure after massive hepatectomy[J]. Cell Transplant, 2016, 25(8): 1547-1559.
[21]	丁义涛, 江春平. 肝切除术后肝功能衰竭：病理生理、危险因素与临床治疗[J]. 中华肝胆外科杂志, 2011, 17(4):279-282.

临床参数		无衰竭组	衰竭组	统计值	P值
性别（男/女）		35/54	12/16	χ²=0.111	0.740
年龄（岁，±s）		38±14	34±13	t=1.202	0.232
体重（kg，±s）		56±11	58±10	t=-0.769	0.443
TB[μmol/L，M（Q₂₅，Q₇₅）]		8(6~13)	14(8~46)	Z=-2.929	0.003
ALB（g/L，±s）		36±5	33±5	t=2.391	0.018
Plt（×109/L，±s）		271±91	283±105	t=-0.607	0.545
胆碱酯酶（U/L，±s）		5 672±1 848	4 597±2 121	t=2.591	0.011
ALT[U/L，M（Q₂₅，Q₇₅）]		28(17~48)	32(20~60)	Z=-0.818	0.413
AST[U/L，M（Q₂₅，Q₇₅）]		29(21~46)	43(26~63)	Z=-1.997	0.046
ALP[U/L，M（Q₂₅，Q₇₅）]		136(85~228)	237(137~477)	Z=-2.469	0.014
GGT[U/L，M（Q₂₅，Q₇₅）]		63(27~144)	96(51~226)	t=-1.562	0.118
合并肝脏疾病（例）		23	16	χ²=9.390	0.002
远隔器官转移		15	18	χ²=23.664	0.000
病灶直径≥10 cm（例）		37	18	χ²=4.111	0.036
Child-Pugh分级		?	?	χ²=20.914	0.000
?	A级	76	12	?	?
?	B级	12	14	?	?
?	C级	1	2	?	?
白蛋白/球蛋白比值		?	?	χ²=18.533	0.000
?	< 1.0	29	22	?	?
?	1.0～1.3	42	5	?	?
?	> 1.3	18	1	?	?
手术时间（例）		?	?	χ²=17.333	0.000
?	< 3 h	56	5	?	?
?	≥3 h	33	23	?	?
术中出血量（例）		?	?	χ²=21.447	0.000
?	< 1 000 ml	63	6	?	?
?	≥1 000 ml	26	22	?	?
手术方式（例）		?	?	χ²=0.001	0.982
?	非解剖性肝切除	32	10	?	?
?	半肝或肝叶切除	57	18	?	?
肝血流阻断		36	10	χ²=0.200	0.655
术中输血		13	18	χ²=26.991	0.000

临床参数		无衰竭组	衰竭组	统计值	P值
性别（男/女）		35/54	12/16	χ²=0.111	0.740
年龄（岁，±s）		38±14	34±13	t=1.202	0.232
体重（kg，±s）		56±11	58±10	t=-0.769	0.443
TB[μmol/L，M（Q₂₅，Q₇₅）]		8(6~13)	14(8~46)	Z=-2.929	0.003
ALB（g/L，±s）		36±5	33±5	t=2.391	0.018
Plt（×109/L，±s）		271±91	283±105	t=-0.607	0.545
胆碱酯酶（U/L，±s）		5 672±1 848	4 597±2 121	t=2.591	0.011
ALT[U/L，M（Q₂₅，Q₇₅）]		28(17~48)	32(20~60)	Z=-0.818	0.413
AST[U/L，M（Q₂₅，Q₇₅）]		29(21~46)	43(26~63)	Z=-1.997	0.046
ALP[U/L，M（Q₂₅，Q₇₅）]		136(85~228)	237(137~477)	Z=-2.469	0.014
GGT[U/L，M（Q₂₅，Q₇₅）]		63(27~144)	96(51~226)	t=-1.562	0.118
合并肝脏疾病（例）		23	16	χ²=9.390	0.002
远隔器官转移		15	18	χ²=23.664	0.000
病灶直径≥10 cm（例）		37	18	χ²=4.111	0.036
Child-Pugh分级		?	?	χ²=20.914	0.000
?	A级	76	12	?	?
?	B级	12	14	?	?
?	C级	1	2	?	?
白蛋白/球蛋白比值		?	?	χ²=18.533	0.000
?	< 1.0	29	22	?	?
?	1.0～1.3	42	5	?	?
?	> 1.3	18	1	?	?
手术时间（例）		?	?	χ²=17.333	0.000
?	< 3 h	56	5	?	?
?	≥3 h	33	23	?	?
术中出血量（例）		?	?	χ²=21.447	0.000
?	< 1 000 ml	63	6	?	?
?	≥1 000 ml	26	22	?	?
手术方式（例）		?	?	χ²=0.001	0.982
?	非解剖性肝切除	32	10	?	?
?	半肝或肝叶切除	57	18	?	?
肝血流阻断		36	10	χ²=0.200	0.655
术中输血		13	18	χ²=26.991	0.000

因素	B	SE(b)	OR	Wald χ²	P值	95%CI
ALB	-0.090	0.084	0.914	1.153	0.384	0.775～1.077
胆碱酯酶	0.000	0.000	1.000	0.799	0.686	0.999～1.000
白蛋白/球蛋白比值≤1.3	-0.454	1.231	0.635	0.136	0.713	0.057～7.098
术中出血量≥1 000 ml	1.785	0.792	5.961	5.087	0.024	1.263～28.125
病灶直径≥10 cm	-0.925	0.796	0.396	1.352	0.245	0.083～1.886
手术时间>3 h	2.070	1.029	7.926	4.049	0.044	1.055～59.529
合并肝脏基础疾病	2.003	0.738	7.412	7.371	0.007	1.745～31.476
Child-Pugh分级A级	-2.420	0.925	0.089	6.853	0.009	0.015～0.544
远隔器官转移	0.037	0.786	1.038	0.002	0.963	0.222～4.846
术中输血	2.428	0.940	11.341	6.681	0.010	1.799～71.511
ALP	-0.003	0.001	0.997	3.518	0.061	0.995～1.000
AST	0.010	0.004	1.010	6.872	0.009	1.003～1.018
TB	0.002	0.005	1.002	0.186	0.666	0.993～1.012

因素	B	SE(b)	OR	Wald χ²	P值	95%CI
ALB	-0.090	0.084	0.914	1.153	0.384	0.775～1.077
胆碱酯酶	0.000	0.000	1.000	0.799	0.686	0.999～1.000
白蛋白/球蛋白比值≤1.3	-0.454	1.231	0.635	0.136	0.713	0.057～7.098
术中出血量≥1 000 ml	1.785	0.792	5.961	5.087	0.024	1.263～28.125
病灶直径≥10 cm	-0.925	0.796	0.396	1.352	0.245	0.083～1.886
手术时间>3 h	2.070	1.029	7.926	4.049	0.044	1.055～59.529
合并肝脏基础疾病	2.003	0.738	7.412	7.371	0.007	1.745～31.476
Child-Pugh分级A级	-2.420	0.925	0.089	6.853	0.009	0.015～0.544
远隔器官转移	0.037	0.786	1.038	0.002	0.963	0.222～4.846
术中输血	2.428	0.940	11.341	6.681	0.010	1.799～71.511
ALP	-0.003	0.001	0.997	3.518	0.061	0.995～1.000
AST	0.010	0.004	1.010	6.872	0.009	1.003～1.018
TB	0.002	0.005	1.002	0.186	0.666	0.993～1.012

Please choose a citation manager

Content to export