肝切除术后肝功能失代偿的相关风险指标分析

目的 探讨肝切除术后肝功能失代偿的风险指标。方法 回顾性分析2015年1月~2018年3月我院225例实施肝部分切除术患者的围手术期临床资料，包括人口统计学指标（性别，年龄，手术指征，相关病史），术中情况（肝门阻断时间，肝切除范围，失血量，输血量），术后病理诊断及血清生化指标[总胆红素（TB），前白蛋白（PA），白蛋白（ALB），谷丙转氨酶（ALT），谷草转氨酶（AST），胆碱酯酶（ChE），γ-谷氨酰转移酶（γ-GT）]，术后住院时间等。筛选出与术后肝功能失代偿相关的风险指标。结果 225例患者中，24例（10.71%）出现术后肝功能失代偿。肝功能失代偿患者平均年龄高于肝功能代偿患者[（62.32±7.71）岁 vs （55.12±11.00）岁]，差异有统计学意义（P＜0.05）。术后第3天，肝功能失代偿患者PA和ChE分别为（65.55±48.23）mg/L和（3400.00±1610.72）IU/L，低于肝功能代偿患者的（111.00±54.93）mg/L和（5146.57±2115.63）IU/L，差异具有统计学意义（P＜0.05），其余指标差异无统计学意义（P＞0.05）。相关性分析结果显示，PA及ChE均与手术方式相关（P＜0.05）。ROC曲线提示，年龄≥62岁，术后PA≤100 mg/L及ChE≤4348 IU/L的患者，术后发生肝功能失代偿的风险显著提高。结论 肝切除术前肝功能Child-Pugh分级A级的患者，术后仍有可能发生肝功能失代偿。结合患者年龄、PA、ChE等指标，可以有效评估部分肝切除患者围手术期肝脏储备功能，预测术后肝功能失代偿的发生。

Analysis of Risk Indicators Related to Liver Function Decompensation after Hepatectomy

Abstract:Objective To investigate the risk index of liver function decompensation after hepatectomy.Methods The perioperative clinical data of 225 patients undergoing partial hepatectomy in our hospital from January 2015 to March 2018 were retrospectively analyzed, including demographic indicators (gender, age, surgical indications, related medical history). Situation (hepatic occlusion time, liver resection range, blood loss, blood transfusion), postoperative pathological diagnosis and serum biochemical indicators [total bilirubin (TB), prealbumin (PA), albumin (ALB), valley Alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholinesterase (ChE), γ-glutamyltransferase (γ-GT), postoperative hospital stay, etc. Risk indicators associated with postoperative liver function decompensation were screened.Results Of the 225 patients, 24 (10.71%) had postoperative liver decompensation. The mean age of patients with hepatic decompensation was higher than that of patients with liver function compensation [(62.32±7.71) years vs. (55.12±11.00) years], the difference was statistically significant (P<0.05). On the third postoperative day, PA and ChE were (65.55±48.23) mg/L and (3400.00±1610.72) IU/L, respectively, which was lower than that of patients with liver function compensation (111.00±54.93) mg/ L and (5146.57±2115.63) IU/L, the difference was statistically significant (P<0.05), and the other indicators were not statistically significant (P>0.05). Correlation analysis showed that both PA and ChE were associated with surgical methods (P<0.05). The ROC curve suggests that patients with age ≥ 62 years, postoperative PA ≤ 100 mg / L and ChE ≤ 4348 IU / L, the risk of liver function decompensation increased significantly after surgery.Conclusion Patients with liver function Child-Pugh grade A before hepatectomy may still have liver function decompensation after surgery. Combined with the patient's age, PA, ChE and other indicators, it can effectively evaluate the perioperative liver reserve function of partial hepatectomy patients and predict the occurrence of postoperative liver function decompensation.