CAJ | 학술논문

目的探讨影响原发性肝细胞癌(HCC)肝切除术后持续低蛋白血症的因素.方法回顾性分析2007年3月至2010年7月川北医学院附属医院收治的行肝切除术的88例HCC患者的临床资料.用Logistic同归模型对肝切除术后持续低蛋白血症发生的相关因素进行单因素和多因素分析.应用ROC曲线评估术后持续低蛋白血症发生的风险,并作风险等级划分.结果共有17例患者术后持续低蛋白血症.单因素分析结果显示,腹腔积液、Child分级、肿瘤直径、术中出血量及输血量、术前ALP及Hb、术前WBC≥10×109/L、术前AST等于或高于正常值2倍以及肝门阻断等与术后持续低蛋白血症的发生相关( OR=2.592,5.154,6.848,2.249,3.336,5.296,0.285,15.000,3.281,1.716,P＜0.05).多因素分析结果显示肿瘤直径、术前Hb、肝门阻断是影响患者术后是否发生持续低蛋白血症的独立危险因素(Wald=9.326,6.151,4.253,P＜0.05).不同风险等级的患者术后持续低蛋白血症的发生率差异有统计学意义(x2=18.607,P＜0.05).结论术前纠正贫血、术中尽量采用半肝阻断能减少术后持续低蛋白血症发生的风险.
목적 탐토영향원발성간세포암(HCC)간절제술후지속저단백혈증적인소.방법 회고성분석2007년3월지2010년7월천북의학원부속의원수치적행간절제술적88례HCC환자적림상자료.용Logistic동귀모형대간절제술후지속저단백혈증발생적상관인소진행단인소화다인소분석.응용ROC곡선평고술후지속저단백혈증발생적풍험,병작풍험등급화분.결과 공유17례환자술후지속저단백혈증.단인소분석결과현시,복강적액、Child분급、종류직경、술중출혈량급수혈량、술전ALP급Hb、술전WBC≥10×109/L、술전AST등우혹고우정상치2배이급간문조단등여술후지속저단백혈증적발생상관( OR=2.592,5.154,6.848,2.249,3.336,5.296,0.285,15.000,3.281,1.716,P＜0.05).다인소분석결과현시종류직경、술전Hb、간문조단시영향환자술후시부발생지속저단백혈증적독립위험인소(Wald=9.326,6.151,4.253,P＜0.05).불동풍험등급적환자술후지속저단백혈증적발생솔차이유통계학의의(x2=18.607,P＜0.05).결론 술전규정빈혈、술중진량채용반간조단능감소술후지속저단백혈증발생적풍험.
Objective To investigate the factors related to continual hypoproteinemia after hepatectomy for patients with hepatocellular carcinoma (HCC).Methods The clinical data of 88 patients with HCC who received hepatectomy at the Affiliated Hospital of North Sichuan Medical College from March 2007 to July 2010 were retrospectively analyzed.Multivariate and univariate analysis of the factors related to continual hypoproteinemia after hepatectomy were performed using Logistic regression model.Risk factors of hypoproteinemia and risk stratification were analyzed by using the receiver operator characteristic (ROC) curve.Results Seventeen patients were complicated with continual hypoproteinemia postoperatively.The results of univariate analysis revealed that pleural effusion,Child classification,tumor diameter,volume of intraoperative blood loss and blood transfusion,preoperative alkaline phosphatase level,preoperative hemoglobin level,preoperative white blood cells ≥ 10 × 109/L,preoperative aspartate aminotransferase 2 times higher than the normal level,portal vein occlusion were correlated with postoperative continual hypoproteinemia ( OR =2.592,5.154,6.848,2.249,3.336,5.296,0.285,15.000,3.281,1.716,P ＜0.05 ).The result of multivariate analysis revealed that the diameter of tumor,preoperative hemoglobin concentration and hepatic portal occlusion were correlated with postoperative continual hypoproteinemia (Wald =9.326,6.151,4.253,P ＜ 0.05).There was a significant difference in the incidence of postoperative continual hypoproteinemia among patients with different risk stratification (x2 =18.607,P ＜ 0.05).Conclusion Improving anemia and hemihepatic vascular control instead of hepatic portal occlusion can help to reduce the risk of postoperative continual hypoproteinemia.