肝癌肝切除术后肝衰竭危险因素的Meta分析

目的探讨我国肝癌肝切除术后肝衰竭(PHLF)发生的危险因素,为预测和预防术后肝衰竭的发生提供理论依据。方法检索中国生物医学文献服务系统、维普、中国知网、万方等数据库,并辅以手工检阅相关论文及其参考文献,收集我国自1990年1月至2013年6月期间公开发表的有关PHLF危险因素的相关文献,运用Meta分析方法进行合并分析。结果共纳入11项研究,2859例肝癌手术切除患者。Meta分析结果显示术前Child-Pugh A级PHLF发生率明显低于对照组(合并OR值为6.28,95%CI:4.55~8.65);术前前白蛋白水平低于170 mg/dl组患者术后肝衰竭发生率增高(合并OR值为4.96,95%CI:3.03~8.10);合并肝硬化组术后肝衰竭发生率高于未合并肝硬化组(合并OR值为4.14,95%CI:2.46~6.98);术中失血量1000 ml组术后肝衰竭发生率较对照组低(合并OR值为5.62,95%CI:3.46~9.11);肿瘤直径10 cm组(合并OR值为2.69,95%CI:1.58~4.57)及切肝范围半肝组(合并OR值为1.64,95%CI:1.12~2.40)肝衰竭发生率均低于对照组;年龄≥60岁(合并OR值为1.73,95%CI:1.25~2.39)、术中输血(合并OR值为3.79,95%CI:2.20~6.51)增加术后肝衰竭发生率。性别、术中是否阻断入肝血流与术后肝衰竭发生无相关性(P0.05)。结论年龄、术前Child-Pugh分级、前白蛋白水平、术中失血量、肿瘤直径、切肝范围、合并肝硬化、术中输血等是影响PHLF发生的危险因素。

Meta -analysis of risk factors for posthepatectomy liver failure in patients with hepatocellular carcinoma

Objective To investigate the risk factors for posthepatectomy liver failure （PHLF）in patients with hepatocellular carcinoma （HCC）and to provide a theoretical basis for the prediction and prevention of PHLF.Methods A meta -analysis was performed on the studies on risk factors for PHLF in HCC patients published in China from January 1990 to June 2013 by searching SinoMed,VIP,CNKI, and Wanfang Data and manual retrieval of related articles and references.Results A total of 11 studies involving 2859 patients treated with hepatectomy were included in the meta -analysis.The incidence of PHLF was significantly lower in Child -Pugh A patients than in the con-trol group （pooled OR =6.28,95%CI：4.55 -8.65）.Patients with prealbumin levels less than 170 mg/dl had an increased incidence of PHLF （pooled OR =4.96,95%CI：3.03 -8.10）.Patients with cirrhosis had a higher incidence of PHLF than those without cirrhosis （pooled OR =4.14,95%CI：2.46 -6.98）.Patients with an intraoperative blood loss less than 1000 ml had a lower incidence of PHLF than the control group （pooled OR =5.62,95%CI：3.46 -9.11）.The incidence of PHLF was lower in patients with a tumor diameter less than 10 cm and patients with an extent of resection less than hepatectomy than in the control group （pooled OR =2.69,95% CI：1.58-4.57;pooled OR =1.64,95%CI：1.12 -2.40）.Age ≥60 years and intraoperative blood transfusion increased the incidence of PHLF （pooled OR =1.73,95% CI：1.25 -2.39;pooled OR =3.79,95% CI：2.20 -6.51）.Sex and hepatic inflow occlusion were not sig-nificantly associated with the development of PHLF （P 〉0.05）Conclusion Advanced age,advanced preoperative Child -Pugh class,low prealbumin level,high intraoperative blood loss,large tumor diameter,large extent of hepatectomy,cirrhosis,and intraoperative blood transfusion are risk factors for the development of PHLF.