HCC切除术后预测肝功能不全的风险模型分析

摘要/Abstract

摘要： 目的研究肝细胞肝癌(HCC)切除术后预测肝功能不全的危险因素。方法回顾性分析2017年4月至2019年7月广安市人民医院收治的198例接受肝切除术治疗的HCC患者的临床资料。统计患者术前吲哚菁绿15min滞留率(ICG-R15)、血清白蛋白(Alb)等指标,分析术后肝功能不全发生情况,并采用多因素logistic回归分析HCC切除术后肝功能不全的独立影响因素。结果 98例患者均成功行肝切除术,术后有60例(30.30%)患者发生肝功能不全。多因素logistic回归分析显示,Alb(OR=1.752,95%CI=1.113～2.758)、ICG-R15(OR=1.136,95%CI=1.026～1.258)、肝门阻断时间(OR=1.129,95%CI=1.002～1.272)、肝切除量(OR=2.118,95%CI=1.070～4.192)、手术时间(OR=1.007,95%CI=1.001～1.013)是HCC切除术后肝功能不全的独立影响因素(P<0.05)。结论 HCC切除术后肝功能不全与术前ICG-R15增加、血清Alb水平下降、肝门阻断时间及手术时间延长、肝切除量增加有关。

关键词: 原发性肝细胞癌, 肝切除术, 肝功能不全, 吲哚菁绿排泄试验, 肝门阻断时间

Abstract: Objective To study the risk factors for liver dysfunction after liver resection for hepatocellular carcinoma (HCC).Methods The clinical data of 198 HCC patients admitted to our hospital from April 2017 to July 2019 who received hepatectomy were retrospectively analyzed. The retention rate of indocyanine green at 15 minutes (ICG-R15), serum albumin (ALB) before surgery, and postoperative liver function were recorded. Multivariate logistic regression was used to analyze the independent risk factors for liver dysfunction after liver resection for HCC. Results All the 198 patients underwent hepatectomy successfully, and 60 patients (30.30%) had hepatic dysfunction after operation. Multivariate logistic regression analysis showed that ALB [odd ratio (OR)=1.752, 95% confidence interval (CI) = 1.113-2.758], ICG-R15 (OR=1.136, 95% CI = 1.026-1.258), hepatic portal occlusion time (OR=1.129, 95% CI = 1.002-1.272), resected liver volume (OR=2.118, 95% CI = 1.070-4.192), and operation time (OR=1.007, 95% CI = 1.001-1.013) were independent risk factors for postoperative liver dysfunction (P<0.05).Conclusion Liver dysfunction after liver resection for HCC is associated with high preoperative ICG-R15, low serum ALB level, long time of hepatic portal occlusion and operation, and large resected liver volume.

Key words: Primary hepatocellular carcinoma, Hepatectomy, Liver dysfunction, Indocyanine green clearance test, Hepatic portal occlusion time

王硕, 徐玉彬. HCC切除术后预测肝功能不全的风险模型分析[J]. 肝脏, 2020, 25(5): 476-479.

WANG Shuo, XU Yu-bin. Risk prediction model of liver dysfunction after liver resection for HCC[J]. Chinese Hepatolgy, 2020, 25(5): 476-479.

参考文献

[1] 张杰, 段伯焕, 朱功兵. 肝细胞癌患者外科手术根治术后生存分析. 实用肝脏病杂志, 2017, 20:93-96.
[2] 中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 临床肝胆病杂志, 2011, 20:929-946.
[3] Rahbari NN , Garden OJ , Padbury R , et al. Posthepatectomy liver failure: a definition and grading by the international study group of liver surgery (ISGLS). Surgery, 2011, 149:713-724.
[4] 刘爱祥, 王海清, 薄文滔, 等. 肝细胞癌肝切除术的临床疗效及预后因素分析. 中华消化外科杂志, 2019, 18:368-374.
[5] Hou YF, Wei YG, Yang JY , et al. Microvascular invasion patterns affect survival in hepatocellular carcinoma patients after second hepatectomy. J Surg Res, 2016, 200:82-90.
[6] 梅理祥, 李增博, 谢艳会, 等. 肝切除术后第3天ICG-R15对肝细胞肝癌术后肝功能不全的预测价值. 中国普通外科杂志, 2016, 25:1180-1185.
[7] 刘发强, 王黎明, 荣维淇, 等. 肝细胞癌肝部分切除术后营养支持的效果. 中华肿瘤杂志, 2018, 40:787.
[8] 欧阳高雄, 刘剑勇, 张志明, 等. 标准残肝体积联合肝纤维化评分指标对HCC肝切除术安全性评估. 中华肿瘤防治杂志, 2018,25:499-505.
[9] 王骏成, 劳向明. HBV相关肝癌TACE术后HBV DNA及肝功能变化的研究进展. 新医学, 2016, 47:290-294.
[10] 於展飞, 熊明涛. 半肝切除术中吲哚氰绿清除试验对残余肝脏储备功能的评估价值. 中外医学研究, 2015,13:147-148.
[11] 贾信奇, 苏志雷, 赵俊杰, 等. 吲哚氰绿代谢试验在肝脏病变中的应用及进展. 肝脏, 2019,24:580-582.
[12] 赖瑞敏, 王明芳, 朱月永. 吲哚菁绿清除试验对乙型肝炎肝硬化患者肝脏储备功能的评估价值. 临床肝胆病杂志, 2016, 32:1739-1742.
[13] 王小明, 胡明华, 王冠男,等. ICG-R15联合三维可视化技术用于巨块型肝癌治疗决策22例分析. 中国实用外科杂志, 2019, 39:737-738.
[14] 张旭东, 胡玉霆. 渐进式肝门阻断法在肝切除手术中的应用. 实用临床医药杂志, 2019,23:64-66.
[15] 胡朝辉, 陈熙, 罗华. 左半肝切除术中应用Pringle法联合左肝静脉阻断的临床体会. 腹腔镜外科杂志, 2019, 24:333-338.