联合半肝切除的肝门部胆管癌根治术后发生急性肝衰竭的危险因素分析  

Risk factors for acute liver failure after radical surgery combined with hemihepatectomy for hilar cholangiocarcinoma

作　　者：张毅[1] 张杰峰[1] 张艳林[1] 张希[1] 曾建挺[1] 邓和军[1] 

机构地区：[1]重庆市肿瘤研究所肝胆外科,重庆400030

出　　处：《临床肝胆病杂志》2016年第10期1936-1938,共3页Journal of Clinical Hepatology

摘　　要：目的探讨联合半肝切除的肝门部胆管癌（HC）根治术后发生急性肝衰竭的危险因素。方法回顾性分析重庆市肿瘤研究所2000年1月-2014年12月收治的行联合半肝切除的HC根治术的126例患者的临床资料,包括性别、年龄、术前血清TBil、Alb水平,是否保留肝动脉血供,是否行非选择性肝血流阻断,术中失血量和手术时间。计数资料组间比较采用χ2检验,进一步采用Logistic多因素回归分析患者术后发生急性肝衰竭的独立危险因素。结果共有17例（13.49%）发生急性肝衰竭,其中死亡11例（8.73%）。术前血清TBil〉200μmol/L[比值比（OR）=1.78,95%可信区间（95%CI）：1.05-3.04,P=0.029]、术中失血量〉800 ml（OR=2.64,95%CI：1.33-3.95,P=0.037）、未保留肝动脉血供（OR=3.57,95%CI：2.21-5.09,P=0.002）、采用非选择性肝血流阻断（OR=1.36,95%CI：0.79-1.78,P=0.037）是术后发生急性肝衰竭的独立危险因素。结论术前减黄、减少术中出血、保留肝动脉血供、避免非选择性肝血流阻断对于减少联合半肝切除的HC根治术后发生急性肝衰竭有重要意义。Objective To investigate the high-risk factors for acute liver failure after radical surgery combined with hemihepatectomy for hilar cholangiocarcinoma（ HC）. Methods A retrospective analysis was performed for the clinical data of 126 patients who were admitted to Chongqing Cancer Institute and underwent radical surgery combined with hemihepatectomy for HC from January 2000 to December 2014,including sex,age,preoperative serum levels of total bilirubin（ TBil） and albumin（ Alb）,preservation of hepatic artery blood supply or not,application of nonselective hepatic vascular occlusion or not,intraoperative blood loss volume,and time of operation. The chi-square test was used for comparison of categorical data between groups,and multivariate logistic regression analysis was performed to determine independent risk factors for acute liver failure after surgery. Results A total of 17 patients（ 13. 49%） experienced acute liver failure,and 11 patients（ 8. 73%） died. A preoperative serum TBil level of 200 μmol / L（ OR = 1. 78,95% CI： 1. 05-3. 04,P = 0. 029）,an intraoperative blood loss volume of 800 ml（ OR = 2. 64,95% CI： 1. 33-3. 95,P = 0. 003）,no preservation of hepatic artery blood supply（ OR = 3. 57,95% CI：2. 21-5. 09,P = 0. 002）,and application of nonselective hepatic vascular occlusion（ OR = 1. 36,95% CI： 0. 79-1. 78,P = 0. 037） were independent risk factors for acute liver failure after surgery. Conclusion Preoperative biliary drainage,a reduced intraoperative blood loss volume,preservation of hepatic artery blood supply,and avoiding nonselective hepatic vascular occlusion have great significance in reducing acute liver failure after radical surgery combined with hemihepatectomy for HC.

关 键 词：胆管肿瘤 肝功能衰竭 急性 危险因素 

分 类 号：R735.8[医药卫生—肿瘤]