影响乙型肝炎肝硬化相关肝细胞癌患者肝切除术后急性肝衰竭的临床因素分析

摘要/Abstract

摘要： 目的分析乙型肝炎肝硬化肝细胞癌患者行肝切除术后发生急性肝功能衰竭可能的危险因素。方法 2019年6月—2021年6月河南省人民医院收治的乙型肝炎肝硬化后肝癌经手术治疗的患者61例。观察患者术后急性肝功能衰竭发生情况,记录患者一般临床资料并对可能的危险因素进行分析。结果 61例乙型肝炎肝硬化相关肝细胞癌患者PHLF 10例(PHLF组),未发生PHLF 51例(非PHLF组)。PHLF组和非PHLF组年龄分别为(58.3±4.9)岁和(45.8±5.6)岁,差异具有统计学意义(P<0.05);PHLF组Child-Pugh A、B及C级分别为3例(30.0%)、7例(70.0%)及0(0),非PHLF组分别级分别为36例(70.6%)、15例(29.4%)及0(0),差异具有统计学意义(P<0.05);PHLF组肿瘤直径、术中出血量、手术时间分别为(9.3±1.9)cm、(1235.89±158.0)mL及(267.15±59.5)min,与非PHLF组[(6.2±1.5)cm、(879.5±105.3)mL及(223.12±39.12)min]相比,差异具有统计学意义(P<0.05);PHLF组不规则切除、肝叶切除分别为3例(30.0%)、7例(70.0%),非PHLF组分别为41例(80.4%)、10例(19.6%),差异具有统计学意义(P<0.05);PHLF组、非PHLF组TACE分别为1例(10.0%)、27例(52.9%),PHLF组、非PHLF组无TACE分别为9例(90.0%)、24例(47.1%),差异具有统计学意义(P<0.05)。将发生急性肝衰竭作为因变量,自变量为上述采用单因素分析中具有统计学意义的因素,应用logistic回归分析。结果显示年龄、Child-pugh分级、肿瘤直径、手术切除范围、术中出血量、术中是否输血、术前是否TACE与发生PHLF具有相关性(P均<0.05)。结论乙型肝炎肝硬化相关肝细胞癌患者肝切除术后出现急性肝衰竭,可能与年龄、Child-Pugh分级、肿瘤直径、手术切除范围、术中出血量、术中是否输血有关,术前行TACE属于保护性因素。

关键词: 肝细胞癌, 肝切除术, 急性肝衰竭, 乙型肝炎肝硬化

Abstract: Objective To analyze the possible risk factors for acute liver failure (ALF) after hepatectomy in patients with hepatitis B virus (HBV) cirrhosis and hepatocellular carcinoma (HCC), and to prevent the occurrence of ALF after liver resection. Methods 61 patients with HCC after HBV cirrhosis in our hospital from June 2019 to June 2021 were selected. The occurrence of postoperative ALF was observed, the general clinical data of patients were recorded, and the possible risk factors were analyzed. Results Among 61 patients with HCC related to HBV cirrhosis, 10 cases with posthepatectomy liver failure (PHLF group), and 51 cases without PHLF (non-PHLF group). The age of PHLF group and non-PHLF group was (58.3 ± 4.9) years and (45.8 ± 5.6) years, and the difference was statistically significant(P<0.05). Child-Pugh grade A, B and C in PHLF group were 3 cases (30.0%), 7 cases (70.0%) and 0(0), while those in non-PHLF group were 36 cases (70.6%), 15 cases (29.4%) and 0(0), the difference was statistically significant(P<0.05). The tumor diameter, intraoperative blood loss and operation time in PHLF group were (9.3 ± 1.9)cm, (1235.89 ± 158.0)mL and (267.15 ± 59.5)min, which were significantly different from those in non-PHLF group [(6.2 ± 1.5)cm and (879.5 ± 105.3)mL and (223.12 ± 39.12)min],the difference was statistically significant(P<0.05). Irregular resection and lobectomy of liver in PHLF group were 3 cases (30.0%) and 7 cases (70.0%), while those in non-PHLF group were 41 cases (80.4%) and 10 cases (19.6%), the difference was statistically significant (P<0.05). Transcatheter arterial chemoembolization (TACE) was found in 1 case (10.0%) and 27 cases (52.9%) in PHLF group and non-PHLF group, and no TACE was found in 9 cases (90.0%) and 24 cases (47.1%) in PHLF group and non-PHLF group, the difference was statistically significant(P<0.05). Whether ALF occurred or not was taken as the dependent variable, and the independent variables were the statistically significant factors in the above univariate analysis. Logistic regression analysis was used. The results showed that age, Child-Pugh grade, tumor diameter, surgical resection range, intraoperative blood loss, intraoperative blood transfusion, preoperative TACE were related to the occurrence of PHLF (P<0.05). Conclusion ALF after hepatectomy in patients with HBV related HCC may be related to age, Child-Pugh grade, tumor diameter, surgical resection range, intraoperative blood loss and intraoperative blood transfusion. Preoperative TACE is a protective factor.

Key words: Hepatocellular carcinoma, Liver resection, Acute liver failure, Hepatitis B cirrhosis

赵子瑜, 王明强, 牛垚飞. 影响乙型肝炎肝硬化相关肝细胞癌患者肝切除术后急性肝衰竭的临床因素分析[J]. 肝脏, 2022, 27(10): 1092-1095.

ZHAO Zi-yu, WANG Ming-qiang, NIU Yao-fei. Clinical factors affecting liver failure in patients with HBV related hepatocellular carcinoma after hepatectomy[J]. Chinese Hepatolgy, 2022, 27(10): 1092-1095.

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