| 艾滋病合并肝细胞癌与非艾滋病肝细胞癌患者肝切除术后并发症及肝功能的比较分析 |
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| 引用本文： | 赵辉,汪勇,许飞龙,刘立志. 艾滋病合并肝细胞癌与非艾滋病肝细胞癌患者肝切除术后并发症及肝功能的比较分析[J]. 中华肥胖与代谢病电子杂志, 2021, 7(3): 152-158. DOI: 10.3877/cma.j.issn.2095-9605.2021.03.003 |
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| 作者姓名： | 赵辉 汪勇 许飞龙 刘立志 |
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| 作者单位： | 1. 510060 广州，广州医科大学附属市八医院肝胆外科2. 510060 广州，广州医科大学附属市八医院感染科3. 中山大学肿瘤防治中心影像科 |
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| 基金项目： | 广州市科技计划项目(201907010043); 广州市科技计划项目(202002020005) |
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| 摘 要： | 目的通过对比艾滋病合并肝细胞癌与非艾滋病肝细胞癌患者肝切除术后并发症及肝功能，分析根治性肝切除术治疗艾滋病合并肝细胞癌的可行性，探讨围手术期死亡率增高的原因。 方法回顾性分析在广州医科大学附属市八医院接受根治性肝切除术的26例艾滋病合并肝细胞癌患者的临床资料，与同期接受根治性肝切除术的75例非艾滋病肝细胞癌患者对比。根据是否合并艾滋病分为艾滋病合并肝细胞癌组即HIV+组与非艾滋病肝细胞癌组即HIV-组。比较两组的并发症、肝功能及围手术期死亡率。计量资料用（±s）表示，组间比较用t检验。计数资料以病例数[n (%)]表示，组间比较采用χ2检验。 结果HIV+组与HIV-组手术方式选择差异无统计学意义（P=0.071）。两组间感染性并发症（P=0.259）、非感染性并发症（P=0.357）发生率差异无统计学意义。两组间术前、术后1 d、3 d、7 d谷丙转氨酶（ALT）、白蛋白、总胆红差异无统计学意义，术前天冬氨酸转氨酶（AST）差异有统计学意义（P<0.001），HIV+组65.4%患者术前AST≥40 U/L。单因素分析术前AST、术后3 d总胆红素、术后7 d白蛋白是预后的影响因素。围手术期3例患者死亡，均为HIV+患者，其中肝功能衰竭死亡2例，出血死亡1例；两组围手术期死亡率差异有统计学意义（P=0.016）。 结论对艾滋病合并肝细胞癌患者行根治性肝切除术是可行的，但更易发生围手术期死亡，肝功能衰竭是围手术期死亡的主要原因，对其肝切除术应更加严格的选择患者。
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| 关 键 词： | 肝细胞癌 肝切除术 人类免疫缺陷病毒 预后 |
| 收稿时间： | 2021-07-18 |
Comparative analysis of complications and liver function after liver resection of patients with hepatocellular carcinoma with and without AIDS |
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| Hui Zhao,Yong Wang,Feilong Xu,Lizhi Liu. Comparative analysis of complications and liver function after liver resection of patients with hepatocellular carcinoma with and without AIDS[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 7(3): 152-158. DOI: 10.3877/cma.j.issn.2095-9605.2021.03.003 |
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| Authors: | Hui Zhao Yong Wang Feilong Xu Lizhi Liu |
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| Affiliation: | 1. Department of Hepatobiliary Surgery, Guangzhou Eighth People's Hospital, Guangzhou Medicial University2. Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medicial University3. Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou 510060, China |
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| Abstract: | ObjectiveTo analyze the feasibility of radical hepatectomy for hepatocellular carcinoma patients complicated with Acquired Immune Deficiency Syndrome (AIDS) by comparing the complications and liver function of patients with hepatocellular carcinoma with and without AIDS and explore the causes of increased perioperative mortality. MethodsThe clinical data of 26 HCC patients with AIDS receiving radical hepatectomy in Guangzhou Eighth People's Hospital were retrospectively analyzed, and compared with 75 HCC patients without AIDS at the same period. The patients were divided into AIDS combined hepatocellular carcinoma group (HIV+group) and non-AIDS hepatocellular carcinoma group (HIV-group) base on the combination of AIDS. Complications, liver function and perioperative mortality were compared between the two groups. Continuous variables were shown as median (IQR), while count data were shown as the number of cases (percent). Student’s t-test and chi square test were used to compare the difference between the two groups. ResultsThere was no significant difference in the choice of surgical methods between HIV+group and HIV-group (P=0.071). There was no significant differences in the incidence of infectious complications (P=0.259) and non-infectious complications (P=0.357) between the two groups. A total of 3 patients died during the perioperative period, all of them were HIV+ patients, including 2 cases of liver failure and 1 case of bleeding; There was a significant difference in perioperative mortality between the two groups (P=0.016). There was no significant difference in ALT, albumin and total bilirubin between the two groups before operation, 1 day, 3 days and 7 days after operation, but there was significant difference in AST before operation (P<0.001). In HIV+group, 65.4% patients had AST≥40 U/L before operation. Univariate analysis showed that AST before operation, total bilirubin 3 days after operation and albumin 7 days after operation were the influencing factors of prognosis. ConclusionsRadical hepatectomy is feasible for hepatocellular carcinoma with AIDS, but HIV+ patients are more likely to die in perioperative period and liver failure is the main causeof perioperative death, so patients should be selected more strictly for hepatectomy. |
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| Keywords: | Hepatocellular carcinoma Hepatectomy Human immunodeficiency virus Prognosis |
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