肝细胞肝癌术后大量腹水预测评分体系的建立

目的 通过对肝细胞肝癌患者术后大量腹水形成相关因素的分析,建立一套预测术后大量腹水形成的评分体系.方法 回顾性分析2005年1月至2010年1月收治的324例肝细胞肝癌患者的术后腹水发生情况,男性282例,女性42例,年龄17～84岁,中位年龄54岁.根据腹水量的多少,将患者分为两组:大量腹水组(n=78)和少量腹水组(n=246).通过统计学分析筛选出与术后腹水形成密切相关的术前、术中及术后因素,并建立评分系统.结果 单因素分析显示,大量腹水组患者有无肝硬化、凝血功能、血小板计数、血浆白蛋白及天冬氨酸转氨酶等术前指标,以及手术时间、术中出血量、术中输血浆量、术中输红细胞量、半肝(含半肝)以上切除等因素,与少量腹水组相比差异有统计学意义(P＜0.05).多因素回归分析显示,术前血小板计数、天冬氨酸转氨酶、是否行半肝以上(含半肝)切除、术中输注血浆量、术后第1天尿量及术后第1天引流量是术后产生大量腹水的独立相关因素.依据多因素回归分析结果建立的评分系统,预测腹水产生的敏感度为83.3%,特异度为86.2%.结论 肝细胞肝癌术后腹水生成与术前、术中及术后多种因素有关,本研究建立的评分系统可较准确地预测术后大量腹水的生成.

A scoring system to predict ascites after hepatoctomy for hepatocellular carcinoma

Objective To establish a scoring system predicting the ascites postoperatively by analyzing the varient factors associated with massive ascites after hepatectomy in the patients with hepatocellular carcinoma(HCC). Methods From January 2005 to January 2010,324 patients with HCC underwent hepatectomy were analyzed retrospectively. There were 282 male and 42 female,aging from 17 to 84 years(mean age,54 years). They were divided into two groups according to the volume of ascites. Variant preoperative,intraoperative and postoperative factors were compared and a scoring system was established to predict the postoperative ascites. Results The univariate analyses revealed that various preoperative factors including prothrombin time, activated partial thromboplastin time, platelet count, albumin, aspartate aminotransferase had significantly difference in the two groups(P ＜0. 05). The operation time, intraoperative bleeding,hemihepatectomoy or extended hemi-hepatectomy and the request of blood and serum transfusion had significantly difference in the two groups(P ＜0. 05). The multivariate analysis showed that the PLT, AST and the intraoperative plasma transfusion, hemihepatectomy or extended hemi-hepatectomy, the urine output and the drainage in the first postoperative day were independent factors (P ＜ 0. 05) for ascites. A scoring system was established based on the analysis. The specificity and the sensitivity were 86. 2% and 83.3% respectively. Conclution Varient factors are associated with postoperative ascites for hepatecellular carcinoma and the scoring system established can predict the ascites after hepatectomy accurately.