肝癌伴胆管癌栓患者术后发生肝功能衰竭的影响因素研究  

Analysis of Factors Affecting Post- operative Hepatic Failure of Hepatocellular Carcinoma Patients with Bile Duct Thrombi

作　　者：苏瑛[1] 龚昭[1] 

机构地区：[1]武汉市第一医院肝胆外科,430022

出　　处：《实用癌症杂志》2014年第2期233-236,共4页The Practical Journal of Cancer

摘　　要：目的探讨分析肝癌伴胆管癌栓患者术后发生肝功能衰竭的影响因素。方法将108例肝癌伴胆管癌栓患者,按照肝癌切除术后是否发生肝功能衰竭,分为未发生肝功能衰竭组(A组)与发生肝功能衰竭组(B组),采用Logistic二元回归进行单因素分析,并将单因素分析结果具有统计学意义的影响因素,纳入Logistic多元回归模型,再行多因素分析。结果单因素分析发现:手术前总胆红素(TBil)、白蛋白(Alb)、前白蛋白(Pre-Alb)、白球比值(A/G),癌栓位置以及手术后剩余肝脏体积占全肝脏体积的比率等,与患者术后发生肝功能衰竭显著相关(P均<0.05);经多因素分析发现,术后剩余肝脏体积占全肝脏体积的比率<50%、手术前TBil>256.5μmol/L、术前白球比值≤1.3,均是造成该类患者术后发生肝功能衰竭的独立危险因素(P均<0.05)。结论肝癌伴胆管癌栓患者术后是否会发生肝功能衰竭,与手术前TBil水平、术后剩余肝脏体积占全肝脏体积的比率以及术前白球比值等因素有密切关系。手术前后减少与控制各类影响因素,才能有利于控制患者术后肝功能衰竭的发生。Objective To investigate the influence factors of post -operative hepatic failure of Hepatocellular carcinoma ( HCC) patients with bile duct thrombi .Methods 108 cases of HCC patients with bile duct thrombi were divided into without liver failure group( group A) and liver failure group(group B ).Logistic binary regression was used to perform single factor anal-ysis,and the statistically significant influencing factors were analyzed by multivariate analysis using multi -factor logistic regression model.Results Single factor analysis showed that preoperative total bilirubin ,albumin,prealbumin,albumin/globulin ratio,dis-tribution of tumor thrombus and postoperative residual liver volume /total liver volume ratio were correlated with the postoperative liver failure in HCC patients with bile duct tumor thrombus (all P<0.05).Multi-factor analysis showed that postoperative residual liver volume/total liver volume ratio<50%,preoperative total bilirubin >256.5 umol/L and albumin/globulin ratio≤1.3 were independent risk factors of postoperative liver failur (allP<0.05).Conclusion The occurrence of post-operative hepatic failure in Hepatocellular carcinoma ( HCC) patients with bile duct thrombi is closely related with preoperative total bilirubin level ,post-operative residual liver volume/total liver volume ratio ,preoperative albumin/globulin ratio .Reduce and control all kinds of influ-encing factors before and after surgery could help control the occurrence of postoperative liver failure .

关 键 词：肝癌 胆管癌栓 肝功能衰竭 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]