原发性肝癌切除术后高胆红素血症临床分析

目的 探讨原发性肝癌切除术后胆红素变化的规律及导致高胆红素血症的临床因素.方法 回顾性分析97例原发性肝癌切除术患者临床资料,根据术后血清总胆红素水平分为高胆红素组和胆红素正常组,观察术后胆红素变化特点,分析导致术后高胆红素血症的临床因素.结果 红素正常组术后血清总胆红素4 d达峰值[(21.5±9.2)μmol/L],术后14 d可降至正常水平;高胆红素血症组血清总胆红素7 d达峰值[(49.2±25.4)μmol/L],术后14 d仍高于正常值2倍[(36.1 ±17.6)μmol/L].单因素Logistic分析显示:术前胆红素水平,肝功能Child分级,术中肝血流阻断方式,出血量,输血情况以及术后合并低钠血症与术后高胆红素血症有关;多因素Logistic回归分析结果 表明术前胆红素水平是原发性肝癌切除术后高胆红素血症独立预测指标(OR=5.406,χ2=11.319,P=0.001).结论 原发性肝癌切除术后动态监测血清胆红素水平是重要的.围手术期对发生商胆红素血症的相关临床因素积极防范并处理,可降低肝癌切除术后并发症发生率.

Clinical investigation on postoperative high serum bilirubin in patients with primary liver cancer after resection

Objective：To investigate the features of postoperative serum bilirubin changes and the clinical factors associated with high serum bilirubin level in patients with primary liver cancer  after resection.
Methods：The clinical data of 97 patients with primary liver cancer who underwent hepatectomy were analysed retrospectively. The cases were divided into two groups: high serum bilirubin group and normal bilirubin group, respectively, according to serum bilirubin level during two weeks after operation. The features of postoperative serum bilirubin changes and the causitive factors of postoperative high serum bilirubin were analyzed.
Results：The postoperative serum bilirubin reached the peak value［(21.5±9.2)μmol/L］ on d4, and then decreased to normal on d14 in normal bilirubin group. But in high serum bilirubin group the postoperative serum bilirubin reached the peak value［(49.2±25.4)μmol/L］ on the d7, and was still twice more than the normal value ［(36.1±17.6)μmol/L］on  d14. Preoperative serum bilirubin,Child′s grade, types of hepatic vascular occlusion, blood loss, blood transfusion, and postoperative hyponatremia were related with postoperative high serum bilirubin. Preoperative serum bilirubin was an independent factor in predicting postoperative high serum bilirubin(OR=5.406,χ2=11.319,P=0.001）.
Conclusions：It is very important to monitor the posthepatectomy serum bilirubin value dynamically. Preventon and treatment of the causes of perioperative high serum bilirubin may help to decrease the complications of hepatectomy.