肝癌手术切除术前总胆汁酸预测其安全性的价值  

Value of preoperative total bile acid level in predicting safety in hepatectomy for hepatocellular carcinoma

作　　者：于里涵 沈伟峰[1] 李叶晟[1] 郑涛[1] 张敏峰[1] 杨甲梅[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院特需治疗一科/肝移植科,上海200438

出　　处：《中国普通外科杂志》2015年第1期34-38,共5页China Journal of General Surgery

摘　　要：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≥10μmol/L患者手术并发症发生率明显高于TBA水平〈10μmol/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≥10μmol/L,建议选择单一肝段切除或局部切除。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 occurredin 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（P0.05）, while parameters irrelevant to liver function showed no significant difference（all P0.05）, 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 P0.05）. 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（P0.05）.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.

关 键 词：癌 肝细胞 肝切除术 总胆汁酸 肝功能 

分 类 号：R735.7[医药卫生—肿瘤]