血清前白蛋白水平对肝切除术后肝功能不全发生的影响  

Influence of serum prealbumin level on occurrence of posthepatectomy hepatic insufficiency

作　　者：朱倩[1] 李云[1] 段睿[1] 乔国梁[2] 晏建军[2] 严以群[2] 

机构地区：[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

出　　处：《中国普通外科杂志》2016年第1期109-114,共6页China Journal of General Surgery

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。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. M1 operations were performed by the same surgical team and under hepatic inflow occlusion with a clamp/undamp 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 ofposthepatectomy liver failure.

关 键 词：肝肿瘤 肝切除术 肝功能不全 前白蛋白 

分 类 号：R735.7[医药卫生—肿瘤]