半肝切除术后早期肝再生的影响因素分析  

FACTORS AFFECTING EARLY LIVER REGENERATION AFTER HEMIHEPATECTOMY

作　　者：保梅 张嘉军 刘普文 朱呈瞻 邢茂青[1] BAO Mei;ZHANG Jiajun;LIU Puwen;ZHU Chengzhan;XING Maoqing(Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, China)

机构地区：[1]青岛大学附属医院小儿外科,山东青岛266003 [2]威海市立医院关节骨科 [3]青岛大学附属医院(平度)肝胆外科 [4]青岛大学附属医院(市南)肝胆胰外科

出　　处：《精准医学杂志》2022年第2期126-130,136,共6页Journal of Precision Medicine

基　　金：山东省高等学校青创科技支持计划(2020KJL005)。

摘　　要：目的探讨肝胆肿瘤患者半肝切除术后早期肝再生的影响因素。方法选取于青岛大学附属医院肝胆胰外科2014年1月—2020年12月因肝胆肿瘤行半肝切除的患者,82例具有术前增强CT及术后1月CT检查及完整临床资料的患者被纳入研究,采用海信计算机辅助手术系统(CAS)对患者的CT检查进行肝脏三维重建及模拟切除,计算肝脏相关体积,分析术后早期肝脏再生的影响因素。结果82例肝胆肿瘤患者中左、右半肝切除各41例,术后1月中位肝脏再生率为28.5%(左半肝和右半肝组分别为22.3%和33.0%)。单因素分析显示,性别、饮酒史、肝硬化及标准残余肝体积(SRLV)是术后早期肝再生的影响因素(t/χ^(2)=-3.400~10.818,P<0.05);多因素逐步Logistic回归分析显示,SRLV和肝硬化是影响肝切除术后早期肝再生的独立危险因素(OR=1.008、8.244,95%CI=1.003~1.013、2.264~30.013,P<0.05)。结论高SRLV及肝硬化可能会增加肝胆肿瘤术后早期肝再生不良的风险,术前应充分考虑上述因素,以期实现肝胆肿瘤的根治性切除,减少术后并发症,延长患者生存期。Objective To investigate the factors affecting early liver regeneration after hemihepatectomy in patients with hepatobiliary tumors.Methods We selected 82 patients who underwent hemihepatectomy for hepatobiliary tumors in the Department of Hepatobiliary and Pancreatic Surgery,The Affiliated Hospital of Qingdao University from January 2014 to December 2020 and had preoperative enhanced computed tomography(CT),1-month postoperative CT,and complete clinical data.The Hisense computer-assisted surgery system was used to conduct three-dimensional liver reconstruction and simulate resection to calculate the liver volume.Then we analyzed the influencing factors for early liver regeneration after operation.Results Among the 82 patients with hepatobiliary tumors,41 cases each underwent left and right hemihepatectomy.The median liver regeneration rate one month after surgery was 28.5%(22.3%and 33.0%in the left and right hemihepatectomy groups,respectively).Univariate analysis showed that sex,drinking,liver cirrhosis,and standard remnant liver volume(SRLV)were factors affecting early liver regeneration after operation(t/χ^(2)=-3.400-10.818,P<0.05).Multivariate stepwise logistic regression analysis showed that SRLV and liver cirrhosis(OR=1.008,8.244,95%CI=1.003-1.013,2.264-30.013,P<0.05)were independent risk factors affecting early liver regeneration after hepatectomy.Conclusion High SRLV and liver cirrhosis may hinder early liver regeneration after hepatobiliary tumor surgery,which should be fully considered before surgery,in order to achieve radical resection of hepatobiliary tumors,reduce postoperative complications,and prolong the patients’survival.

关 键 词：肝肿瘤 胆道肿瘤 肝切除术 肝再生 器官测量 成像 三维 危险因素 

分 类 号：R735[医药卫生—肿瘤] R333.4[医药卫生—临床医学]