巨大肝癌肝切除术后教科书式结局的影响因素分析  

To investigate the factors influencing the achievement of textbook outcomes in liver surgery(TOLS)after hepatectomy for huge hepatocellular carcinoma

作　　者：胡新源 龚玉勇 陈江明[1] 孙浩楠 陈子祥 耿小平[1] 刘付宝[1] HU Xin-yuan;GONG Yu yong;CHEN Jiang-ming(The First Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230032 [2]六安市第二人民医院普外科,六安237000

出　　处：《肝胆外科杂志》2025年第1期28-33,共6页Journal of Hepatobiliary Surgery

摘　　要：目的探讨巨大肝癌肝切除术后实现教科书式结局(TOLS)的影响因素。方法采用回顾性病例对照研究方法,收集2012年1月至2022年12月安徽医科大学第一附属医院收治的207例巨大肝癌行肝切除术患者的临床病理资料。观察指标:(1)患者一般资料、术前及术后检验指标、手术方式、术中情况、术后并发症情况、术后随访情况;(2)肝切除术后TOLS情况;(3)影响TOLS达成的因素。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。单因素和多因素分析均采用logistic回归模型。结果果(1)治疗情况:207例患者均行开放肝切除术,其中解剖性肝切除109例,非解剖性肝切除98例;行大范围肝切除157例,其中行扩大半肝切除24例;肿瘤单发169例,多发38例;因肿瘤破裂行肝切除术21例。207例患者手术时间为212±75mins,术中出血量419±251mL。119例患者围手术期输血,26例患者发生术中严重不良事件。(2)肝切除术后TOLS情况:其中200例实现R0切除,191例无≥2级术中不良事件,189例无B级和C级术后胆汁漏,202例无B级和C级术后肝衰竭,179例无术后90d内严重并发症,198例无术后90d因严重并发症导致的再人院。207患者中,67.6%(140/207)实现TOLS。(3)术后实现TOLS的影响因素分析:术后实现TOLS的影响因素分析:多因素分析结果显示:合并糖尿病、合并慢性病毒性肝炎、术中出血>400ml、术前HB≤110g/L、肿瘤CNLC分期>I期是影响巨大肝癌患者肝切除术后实现TOLS的独立危险因素。结论TOLS可作为巨大肝癌围术期质控的重要指标,合并糖尿病、合并慢性病毒性肝炎、术中出血大于400mL、术前HB≤110g/L、肿瘤CNLC分期I期是巨大肝癌患者肝切除术后实现TOLS的独立影响因素。在远期预后评估中,达到教科书结局的巨大肝癌肝切除术后患者被认为拥有更好的远期预后。Objective To investigate the factors influencing the achievement of textbook outcomes in liver surgery(TOLS)af-ter hepatectomy for huge hepatocellular carcinoma.Methods A retrospective case-control study was conducted.Clinicopathologic data were collected from 207 patients with giant hepatocellular carcinoma undergoing hepatectomy admitted to the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2022.Observation indexes:(1)Patient's general information,preoperative and postoperative test indices,surgical procedures,intraoperative conditions,postoperative complications,postoperative follow-ups.(2)TO situation after hepatectomy.(3)Influencing factors for TO after hepatectomy.Measurement data with normal distribution was represented Mean Sd.Measurement data with skewed distribution was represented as M(range).Count data was expressed as abso-lute numbers.Logistic regression models were used for univariate and multivariate analysis,in which variables with P<0.10 in univa-riate analysis were included in multivariate analysis.Results(1)Treatment situations:All the 207 patients underwent open hepatec-tomy,including 109 anatomical hepatectomies and 98 non-anatomical hepatectomies;157 cases of extensive hepatectomies,including 24 cases of enlarged hemihepatectomies;169 cases of tumors with single incidence,and 38 cases of multiple incidence;21 cases of hepatectomies due to rupture of tumors.The operative time of the 207 patients was 212±75mins,and the intraoperative Bleeding was 419±251mL.119 patients were transfused perioperatively and 26 patients had intraoperative serious adverse events.(2)TOLS after hepatectomy:207 patients underwent hepatectomy,of which 200 underwent RO resection,191 had no grade≥2 intraoperative adverse time,189 had no grade B and C postoperative bile leakage,202 had no grade B and C postoperative hepatic failure,179 had no serious complication in the postoperative period of 90d,and 198 had no readmission in the postoperative period of 90d due to serious complic

关 键 词：巨大肝癌 肝切除术 教科书式结局 预后 

分 类 号：R735.7[医药卫生—肿瘤]