肝癌切除术后肝功能代偿不全的危险因素分析

目的探讨原发性肝癌术后肝功能代偿不全的危险因素及其防治措施。方法回顾性分析我院6年来手术切除的92例原发性肝癌(PLC)病例的临床资料。结果术后肝功能轻度代偿不全(Ch ild B级)23例(25%),重度代偿不全(Ch ild C级)6例(6.5%)。术后一个月内死亡3例(3.3%)。单变量分析显示:癌灶大小(P<0.01)、切肝方式(P<0.01)、有无肝硬化(P<0.05)和失血总量(P<0.05)与术后肝功能代偿不全有密切关系。结论癌灶巨大、规则性半肝切除术、伴有肝硬化和大量失血是术后肝功能代偿不全主要的危险因素。术中严格地控制出血、在保证完全切除肿瘤的同时尽可能多地保留功能正常的肝组织是提高手术安全性和减少术后并发症的重要措施。

ANALYSIS ON RISK FACTORS LEADING INCOMPLETE COMPENSATION OF LIVER FUNCTION AFTER HEPATECTOMY FOR PRIMARY LIVER CANCER

Objective To explore the risk factors affecting liver function after hepatectomy of primary liver cancer(PLC) and their preventions and treatments.Methods Clinical data of 92 cases with PLC receiving hepatectomy in recent six years were analyzed retrospectively.Result Lightly incomplete compensation of liver function(Child B) was found in 23 cases(25%),seriously incomplete compensation(Child C) in 6 cases(6.5%),and 3 cases(3.3%) died in one month after hepatectomy.The univariate analysis revealed: Tumor diameter(P<0.01),operative procedure(P<0.01),liver cirrhosis(P<0.05) and blood loss(P<0.05) were significantly related with incomplete compensation of liver function after hepatectomy of PLC.Conclusion The main risk factors leading incomplete compensation of liver function were tumor diameter > 10 cm,regular hemi-hepatectomy,liver cirrhosis and blood loss >1500 ml.Controlling intraoperative blood loss and preserving more functioning liver tissue were the important measures to enhance safety for hepatectomy and to decrease the postoperative complications.