肝肿瘤合并肝硬化患者不规则性肝切除术后再手术的危险因素分析  

Risk factors analysis of reoperation after irregular hepatectomy for patients with liver neoplasms and liver cirrhosis

作　　者：汪洋 刘建平[2] 张克韬 

机构地区：[1]公安边防部队总医院普通外科,深圳518029 [2]中山大学孙逸仙纪念医院肝胆胰外科,广州510080

出　　处：《中华肝脏外科手术学电子杂志》2017年第2期108-112,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2011B031800296)

摘　　要：目的分析肝肿瘤合并肝硬化患者不规则性肝切除术后再手术的危险因素。方法回顾性分析2011年1月至2015年1月在中山大学孙逸仙纪念医院行不规则性肝切除术的169例肝肿瘤合并肝硬化患者临床资料。其中男106例,女63例;年龄25~79岁,中位年龄56岁。患者均签署知情同意书,符合医学伦理学规定。根据患者行不规则性肝切除术后是否再手术,将患者分为再手术组(18例)和非再手术组(151例)。观察患者的再手术率及其原因等,并分析影响再手术的危险因素。患者再手术与临床参数的关系分析采用χ~2检验或Fisher确切概率法。患者再手术危险因素分析采用Logistic回归分析。结果本组患者再手术率为10.7%(18/169)。再手术的主要原因为腹腔出血10例,腹腔感染3例,胆漏3例,切口裂开5例。无死亡病例。术前ALB<35 g/L、术前合并糖尿病、术中出血量≥500 ml为肝肿瘤合并肝硬化患者不规则性肝切除术后再手术的独立危险因素(OR=3.775,0.055,0.280;P<0.05)。结论腹腔出血、腹腔感染、胆漏、切口裂开是导致肝肿瘤合并肝硬化患者不规则性肝切除术后再手术的主要原因。术前ALB<35 g/L、术前合并糖尿病、术中出血量≥500 ml是其术后再手术的独立危险因素。Objective To analyze the risk factors of reoperation after irregular hepatectomy for patients with liver neoplasms and liver cirrhosis. Methods Clinical data of 169 patients with liver neoplasms and liver cirrhosis who underwent irregular hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2011 and January 2015 were retrospectively analyzed. Among the patients, 106 were males and 63 were females, aged 25-79 years old with a median age of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the patients received reoperation after irregular hepatectomy or not, all patients were divided into the reoperation group （n=18） and non-reoperation group （n=151）. The reoperation rate and causes were observed, and the risk factors of reoperation were analyzed. The relationship between the reoperation and clinical parameters was analyzed by Chi-square test or Fisher＇s exact probability method. The risk factors ofreoperation were analyzed by Logistic regression analysis. Results The reoperation rate was 10.7% （18/169）. The main causes of reoperation included abdominal bleeding （n=10）, abdominal infection （n=3）, bile leakage （n=3） and incision rupture （n=5）. No death was observed. Preoperative ALB level〈35 g/L, preoperative diabetes mellitus and intraoperative blood loss ≥ 500 ml were the independent risk factors of reoperation after irregular hepatectomy for patients with liver neoplasms and liver cirrhosis （OR=3.775, 0.055, 0.280; P〈0.05）. Conclusions Abdominal bleeding, abdominal infection, bile leakage and insicion rupture are the main casues of reoperation after irregular hepatectomy for the patients with liver neoplasms and liver cirrhosis. Preoperative ALB level〈35 g/L, preoperative diabetes mellitus and intraoperative blood loss≥ 500 ml are the independent risk factors for them.

关 键 词：肝肿瘤 肝硬化 肝切除术 再手术 危险因素 

分 类 号：R657.3[医药卫生—外科学]