轻度贫血患者腹腔镜肝切除术后恢复的影响因素分析  

Factors affecting the recovery of patients with mild anemia after laparoscopic liver resection

作　　者：欧浪 唐善华 张起帆[1] 汤仲舜 黄少坚 饶晓静 李川江[1] 王恺[1] 周杰[1] OU Lang;TANG Shanhua;ZHANG Qifan;TANG Zhongshun;HUANG Shaojian;RAO Xiaojing;LI Chuanjiang;WANG Kai;Zhou Jie(Department of Hepatobiliary Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Southern Medical University,Guangzhou 510515,China;Department of Interventional Diagnosis and Treatment,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院肝胆外科,广东广州510515 [2]南方医科大学,广东广州510515 [3]南方医科大学南方医院血管与介入科,广东广州510515

出　　处：《肝胆胰外科杂志》2023年第6期337-342,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金项目(82170647,82070642);广东省自然科学基金项目(2021A1515012485,2021A1515011015)。

摘　　要：目的通过探讨贫血的相关因素,以及轻度贫血是否会对腹腔镜肝切除术后的肝功能恢复造成影响,从而进一步完善腹腔镜肝切除围术期贫血的管理方案。方法回顾性分析2019年1月至2022年12月间于南方医科大学南方医院300例接受腹腔镜肝切除术患者的临床资料。通过多因素回归分析得出贫血的相关因素,运用倾向性评分匹配(PSM)的方法进行贫血的分组,同时平衡两组的基线数据,比较两组术后各项指标以及术后住院时间的差异。结果肝继发恶性肿瘤和凝血酶原时间是贫血的危险因素,相对于原发性肝癌,肝继发恶性肿瘤发生贫血的风险更大(OR=3.264,P=0.018),凝血酶原时间越长,发生贫血风险越大(OR=2.055,P<0.001);白蛋白和总胆红素是贫血的保护因素,白蛋白越高,贫血风险越低(OR=0.682,P<0.001),总胆红素越高,贫血风险越低(OR=0.909,P=0.020)。四个指标组成的模型有较高的预测价值(AUC=0.876,P<0.001)。经过PSM后共筛选出139例数据,其中贫血44例,非贫血95例。通过对比两组术后各项指标发现,轻度贫血对于腹腔镜肝切除术后肝功能的恢复无显著影响(P>0.05),但贫血患者术后住院时间显著增加(P=0.009)。生存分析提示非贫血患者中位住院时间为5.0 d(95%CI 4.510-5.490),贫血患者中位住院时间为6.0 d(95%CI 5.281-6.719)。结论术前轻度贫血对于腹腔镜肝切除术后肝功能的短期恢复无明显影响,但会导致术后住院时间延长。Objective To explore the factors related to anemia and whether mild anemia affects the recovery of liver function after laparoscopic liver resection,in order to further improve the management of perioperative anemia for laparoscopic liver resection.Methods Clinical data of 300 patients who underwent laparoscopic liver resection between Jan.2019 and Dec.2022 were retrospectively analyzed.Multiple regression analysis was used to identify the factors related to anemia.Propensity score matching(PSM)was used to balance the baseline data of the two groups.The postoperative indicators and hospitalization time were compared between the two groups.Results Hepatic metastatic malignancy and prothrombin time were identified as risk factors for anemia.The occurrence of anemia was higher in patients with hepatic metastatic malignancy than in those with primary liver cancer(OR=3.264,P=0.018),and the risk of anemia increased with longer prothrombin time(OR=2.055,P<0.001).Albumin and total bilirubin were identified as protective factors for anemia.The higher the albumin level,the lower the risk of anemia(OR=0.682,P<0.001),and the higher the total bilirubin level,the lower the risk of anemia(OR=0.909,P=0.020).The model consisting of these 4 indicators had a high prediction value(AUC=0.876,P<0.001).After PSM,139 cases(44 anemia cases and 95 non-anemia cases)were selected for analysis.There was no significant difference in the recovery of liver function between patients with mild anemia and those without anemia after laparoscopic liver resection(P>0.05),but the postoperative hospitalization time of anemia patients was significantly prolonged(P=0.009).Survival analysis showed that the median hospitalization time was 5.0 d(95%CI 4.510-5.490)for non-anemia patients,while it was 6.0 d(95%CI 5.281-6.719)for anemia patients.Conclusion Mild anemia before laparoscopic liver resection does not significantly affect the short-term recovery of liver function,but it may prolong postoperative hospitalization time.

关 键 词：肝肿瘤 腹腔镜手术 肝切除术 贫血 住院时间 

分 类 号：R735.7[医药卫生—肿瘤]