目的：探讨肝细胞癌（HCC）患者术前总胆汁酸（TBA）水平测定的临床意义。 方法：回顾性分析176 例行手术治疗的HCC 患者临床资料，其中Child-Pugh A 级173 例，B 级3 例。分 析患者术前TBA 及其他相关肝功能指标判断肝硬化的敏感性，以及术前TBA 水平与手术并发症的关系。 结果：病理确诊为肝硬化患者88 例；非肝硬化患者中，Knodell 分级达S4 的患者6 例，全组出现手术 相关并发症27 例（15.3%）。与非肝硬化患者比较，肝硬化患者术前TBA 水平明显升高（P<0.05）， 而其他肝功能指标均无统计学差异（均P>0.05）；非肝硬化患者中，Knodell S4 级患者术前TBA 水平 较S1~3 级患者明显升高（均P<0.05）；术前TBA 水平诊断肝硬化的ROC 曲线下面积为0.685，明显 大于其他指标（均P<0.05）。术前TBA 水平≥ 10 μmol/L 患者手术并发症发生率明显高于TBA 水平 <10 μmol/L 患者（P<0.05）。 结论：术前TBA 是评价HCC 患者肝功能的敏感指标，当术前TBA ≥ 10 μmol/L，建议选择单一肝段 切除或局部切除。
Value of preoperative total bile acid level in predicting safety in hepatectomy for hepatocellular carcinoma
Objective: To evaluate the clinical significance of determination of the preoperative level of total bile acid (TBA) in hepatocellular carcinoma (HCC) patients. Methods: The clinical data of 176 HCC patients undergoing surgical treatment were retrospectively analyzed. Of the patients, 173 cases had Child-Pugh A and 3 cases had Child-Pugh B liver function. The sensitivity of the preoperative TBA level and other liver function indexes in estimating liver cirrhosis, and the relationship between preoperative TBA level and operative complications were analyzed. Results: Eighty-eight patients were diagnosed with liver cirrhosis and 6 cases among the non-cirrhotic patients were diagnosed as Knodell stage S4 by postoperative pathology, and surgery-associated complications occurred in 27 patients (15.3%) in the entire group. Compared with non-cirrhotic patients, the preoperative TBA level in patients with liver cirrhosis was significantly increased (P<0.05), while parameters irrelevant to liver function showed no significant difference (all P>0.05), and in non-cirrhotic patients, the preoperative TBA level were significantly higher in cases with Knodell stage S4 than that in those with Knodell stage S1 to S3 (all P<0.05). The incidence of operative complications in patients with preoperative TBA level ≥10 μmol/L was significantly higher than in those with preoperative TBA level <10 μmol/L (P<0.05). Conclusion: Preoperative TBA level is a sensitive indicator for assessing liver function in HCC patients, and in those with preoperative TBA ≥10 μmol/L, uni-segmental or local hepatectomy should be considered.