肝门部胆管癌患者门静脉栓塞术后肝脏低再生的影响因素分析  

Analysis of the influencing factors on low liver regeneration in patients with hilar cholangiocarcinoma after portal venous embolizaion

作　　者：刘广波 陈建斌 赵会博 谢占涛 汤高枫 陈永峰 魏思东 陈国勇 Liu Guangbo;Chen Jianbin;Zhao Huibo;Xie Zhantao;Tang Gaofeng;Chen Yongfeng;Wei Sidong;Chen Guoyong(Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)肝胆胰腺外科,郑州450000

出　　处：《中华肝胆外科杂志》2024年第11期836-839,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(U2004124);河南省科技攻关项目(242102310317)。

摘　　要：目的分析肝门部胆管癌(HCCA)患者门静脉栓塞术(PVE)术后肝脏低再生的影响因素。方法回顾性分析2019年1月至2024年3月于河南省人民医院(郑州大学人民医院)行PVE的HCCA患者临床资料。共纳入62例患者, 其中男性33例, 女性29例, 年龄(59.1±10.3)岁。所有患者根据PVE术后3周残肝体积再生率中位数(28.6%)分组:低再生组(n=31, 残肝体积再生率<28.6%)与高再生组(n=31, 残肝体积再生率≥28.6%)。比较两组区域淋巴结转移、饮酒史、肝纤维化、胆道感染占比及碱性磷酸酶、肿瘤坏死因子-α等。上述P<0.05的变量纳入多因素logistic回归分析, 分析HCCA患者PVE术后肝脏低再生的影响因素。结果低再生组区域淋巴结转移、有饮酒史、肝纤维化、胆道感染占比及碱性磷酸酶、肿瘤坏死因子-α水平均高于高再生组, 差异均有统计学意义(均P<0.05)。多因素logistic回归分析, 区域淋巴结转移(OR=2.561, 95%CI:1.265~5.185)、有饮酒史(OR=2.616, 95%CI:1.321~5.181)、肝纤维化(OR=2.351, 95%CI:1.265~4.369)、胆道感染(OR=2.461, 95%CI:1.226~4.940)及碱性磷酸酶升高(OR=2.687, 95%CI:1.351~5.344)、肿瘤坏死因子-α升高(OR=2.781, 95%CI:1.452~5.326)的HCCA患者PVE术后肝脏低再生风险增加(均P<0.05)。结论区域淋巴结转移、有饮酒史、肝纤维化、胆道感染及碱性磷酸酶、肿瘤坏死因子-α升高是HCCA患者PVE术后肝脏低再生的危险因素, 应密切监测。Objective To analyze the influencing factors of low liver regeneration in patients with hilar cholangiocarcinoma(HCCA)after portal vein embolization(PVE).Method Clinical data of 62 patients with HCCA undergoing PVE at Henan Provincial People's Hospital(People's Hospital of Zhengzhou University)from January 2019 to March 2024 were retrospectively analyzed,including 33 males and 29 females,aged(59.1±10.3)years.Patients were divided into two groups based on the median regeneration rate of remnant liver volume(28.6%)three weeks after PVE:low regeneration(n=31,<28.6%)and high regeneration group(n=31,≥28.6%).The proportion of lymph node metastasis,history of alcohol consumption,liver fibrosis,biliary tract infection,alkaline phosphatase(ALP),and tumor necrosis factor-α(TNF-α)were compared between two groups.Multivariate logistic regression analysis was used to indentify the influencing factors of low liver regeneration in patients with HCCA after PVE surgery.Results The proportion of lymph node metastasis,history of alcohol consumption,liver fibrosis,biliary tract infection,ALP,and level of TNF-αwere higher in the low regeneration group than those in the high regeneration group(all P<0.05).Multivariate logistic regression analysis showed that patients with regional lymph node metastasis(OR=2.561,95%CI:1.265-5.185),history of alcohol consumption(OR=2.616,95%CI:1.321-5.181),liver fibrosis(OR=2.351,95%CI:1.265-4.369),biliary tract infection(OR=2.461,95%CI:1.226-4.940),elevated level of ALP(OR=2.687,95%CI:1.351-5.344),and elevated level of TNF-α(OR=2.781,95%CI:1.452-5.326)had an increased risk of low liver regeneration after PVE(all P<0.05).Conclusion Regional lymph node metastasis,history of alcohol consumption,liver fibrosis,biliary tract infection,and elevated ALP and TNF-αare risk factors for low liver regeneration in patients with HCCA after PVE surgery,which should be noted in clinical practice.

关 键 词：Klatskin肿瘤 肝再生 危险因素 门静脉栓塞术 

分 类 号：R735.7[医药卫生—肿瘤]