临床研究(Clinical Research)

血清前白蛋白水平对肝切除术后肝功能不全发生的影响

Published at: 2016年第25卷第1期

朱倩 1 , 李云 1 , 段睿 1 , 乔国梁 2 , 晏建军 2 , 严以群 2
1 湖北省荆门市第一人民医院 肝胆外科,湖北 荆门 448000
2 中国人民解放军第二军医大学东方肝胆外科医院肝外一科,上海 200438
通讯作者 以群 严 Email: ehbhzq@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.01.017
基金:
湖北省自然科学基金资助项目 2013CFB477

摘要

目的:探讨肝功能Child-Pugh A 级患者行肝切除术后肝功能不全的危险因素。方法:选择2010 年10 月—2014 年4 月间427 例连续的术前肝功能Child-Pugh A 级行肝切除术的原发性肝癌患者。手术均由同一团队实施,均在肝门阻断下进行(肝门阻断15 min/ 间断5 min)。收集患者的临床资料,分析肝切除术后肝功能不全的危险因素。结果:427 例患者中,男362 例,女65 例,平均年龄(51.1±10.4)岁;肝细胞癌391 例,胆管细胞癌31 例,两者混合型5 例;86.4%(369/427)患者有肝炎背景,54.8%(234/427)患者同时伴有肝硬化;≤ 3 个肝段切除与≥ 4 个肝段切除的患者分别为358 例(83.8%)及69(16.2%)例。17 例(4.0%)发生肝切除术后发生功能不全,其中10 例表现为非胆道阻塞、胆汁漏引起的高胆红素血症,6 例患者表现为明显的腹水及凝血时间延长,1 例患者因肝性脑病于术后21 d 死亡。单因素分析发现年龄≥ 60 岁、血清前白蛋白<170 g/L 与术后肝功能不全有关(P=0.045,P=0.009),多因素分析证实血清前白蛋白<170 g/L 是肝切除术后肝功能不全危险因素(HR=3.192,95% CI=1.185~8.601,P=0.022)。结论:血清前白蛋白水平是Child-Pugh A 级患者行肝切除术后肝功能不全的独立影响因素,术前改善患者的营养状况可降低术后肝功能不全的发生率。


Influence of serum prealbumin level on occurrence of posthepatectomy hepatic insufficiency

Abstract

Objective: To determine the risk factors for posthepatectomy liver failure in patients with Child-Pugh A liver function. Methods: From October 2010 to April 2014, 427 consecutive patients with primary liver cancer and preoperative Child-Pugh classification score A liver function undergoing hepatectomy were enrolled. All operations were performed by the same surgical team and under hepatic inflow occlusion with a clamp/unclamp time of 15 min/5 min. The clinical data of the patients were collected, and the risk factors for posthepatectomy liver failure were analyzed. Results: Among the 427 patients, 362 cases were male and 65 were female, with an average age of (51.1±10.4) years; 391 cases underwent surgery for hepatocellular carcinoma (HCC), 31 cases for intrahepatic cholangiocarcinoma (ICC) and 5 cases for mixed HCC and ICC. Of the cases, 86.4% (369/427) had a background of hepatitis B virus infection and 54.8% (234/427) had concomitant cirrhosis; 358 cases (83.8%) had resections of ≤3 segments and 69 cases (16.2%) had resections of ≥4 segments. Seventeen patients (4.0%) developed liver failure after hepatectomy, of whom 10 cases manifested as hyperbilirubinemia unrelated to biliary obstruction or bile leak, 6 cases had clinically apparent ascites and prolonged prothrombin time, and one case had hepatic encephalopathy and died on postoperative day 21. Univariate analysis showed that age ≥ 60 and prealbumin <170 g/L were significantly related to posthepatectomy liver failure (P=0.045, P=0.009), and multivariate analysis identified that prealbumin <170 g/L was independent risk factor for posthepatectomy liver failure (HR=3.192; 95% CI=1.185–8.601, P=0.022). Conclusion: Serum prealbumin level is an independent influential factor for posthepatectomy liver failure in patients with Child-Pugh score A liver function. So improving the nutritional status of the patients may reduce the incidence of posthepatectomy liver failure.


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引用

引用本文: 倩 朱, 云 李, 睿 段, 国梁 乔, 建军 晏, 以群 严. 血清前白蛋白水平对肝切除术后肝功能不全发生的影响[J]. 中国普通外科杂志, 2016, 25(1): 109-114.
Cite this article as: ZHU Qian, LI Yun, DUAN Rui, QIAO Guoliang, YAN Jianjun, YAN Yiqun . Influence of serum prealbumin level on occurrence of posthepatectomy hepatic insufficiency[J]. Chin J Gen Surg, 2016, 25(1): 109-114.