CAJ | 학술논문

目的评价≥65岁老年患者行选择性右肝切除术后的肝功能情况。方法采用回顾性研究，分析行选择性右肝切除术（Ⅴ～Ⅷ段）的24例≥65岁老年患者和22例≤40岁患者的病历资料，统计两组患者的手术死亡、术后并发症和肝功能情况。结果≥65岁老年患者组手术死亡1人，术后严重并发症发生率为12.50％；而≤40岁患者组无手术死亡，术后严重并发症发生率为5.00％，两组手术死亡情况比较，差异无统计学意义（χ2=1.00，P＞0.05），两组的严重并发症发生率经Fisher精确概率法检验，差异亦无统计学意义（P＞0.05）。≥65岁老年患者组需要术中或术后输血8例多于≤40岁患者组6例，但差异无统计学意义（χ2=0.20，P＞0.05），且两组红细胞使用单位数及住院时间比较，差异均亦无统计学意义（t分别=1.04、1.32，P均＞0.05）。两组肝功能变化情况：术后在术后第2天内凝血酶原时间（PT）和总胆红素（TBS）指标变化最明显，PT明显下降，TBS明显上升；术后2～5 d变化缓慢，待术后第5天， PT明显上升，TBS缓慢下降，趋于术前水平。天冬氨酸转氨酶（AST）在术后第2天内迅速上升至最高点，γ谷氨酰胺转肽酶（GGT）缓慢下降至最低点；从第2天开始，AST逐渐下降，GGT缓慢上升至术前水平。丙氨酸转氨酶（ALT）与AST变化趋势一致，碱性磷酸酶（ALP）与GGT变化趋势一致。两组患者变化趋势基本一致。结论≥65岁老年患者行选择性右肝切除术后的肝功能情况与年轻患者（≤40岁）无明显差别。
목적평개≥65세노년환자행선택성우간절제술후적간공능정황。방법채용회고성연구，분석행선택성우간절제술（Ⅴ～Ⅷ단）적24례≥65세노년환자화22례≤40세환자적병력자료，통계량조환자적수술사망、술후병발증화간공능정황。결과≥65세노년환자조수술사망1인，술후엄중병발증발생솔위12.50％；이≤40세환자조무수술사망，술후엄중병발증발생솔위5.00％，량조수술사망정황비교，차이무통계학의의（χ2=1.00，P＞0.05），량조적엄중병발증발생솔경Fisher정학개솔법검험，차이역무통계학의의（P＞0.05）。≥65세노년환자조수요술중혹술후수혈8례다우≤40세환자조6례，단차이무통계학의의（χ2=0.20，P＞0.05），차량조홍세포사용단위수급주원시간비교，차이균역무통계학의의（t분별=1.04、1.32，P균＞0.05）。량조간공능변화정황：술후재술후제2천내응혈매원시간（PT）화총담홍소（TBS）지표변화최명현，PT명현하강，TBS명현상승；술후2～5 d변화완만，대술후제5천， PT명현상승，TBS완만하강，추우술전수평。천동안산전안매（AST）재술후제2천내신속상승지최고점，γ곡안선알전태매（GGT）완만하강지최저점；종제2천개시，AST축점하강，GGT완만상승지술전수평。병안산전안매（ALT）여AST변화추세일치，감성린산매（ALP）여GGT변화추세일치。량조환자변화추세기본일치。결론≥65세노년환자행선택성우간절제술후적간공능정황여년경환자（≤40세）무명현차별。
Objective To evaluate the postoperative liver function of selective right hepatectomy in patients who were older than 65 years old. Methods A total of 24 patients whose age were older than 65 years underwent selective right hepatectomy(segmentsⅤ-Ⅷ) and 22 patients whose age were younger than 40 years were selected to analyze death situa-tion, complication and liver function. Results In patients who were older than 65 years old, there was one case died and the incidence of serious complications was 12.50%. In patients who were younger than 40 years old, there was no death and the severe complication rate was 5.00%. There was no statistic difference in mortality (χ2=1.00,P>0.05) as well as compli-cation rate(P>0.05). Eight cases needed transfusion during or after operation in patients who were older than 65 years old while six cases in patients who were younger than 40 years old, there was no statistic difference (χ2=0.20,P>0.05). The differences of number of red blood cell units and hospital stay had no statistical significance (t=1.04,1.32,P>0.05). Two days after operation, the changes of prothrombin time(PT) decreased and total bilirubin serum(TBS) level increased obvi-ously and then during two to five days after operation, the PT and TBS changed slowly. PT was obviously increasing and TBS was slowly decreasing which trend to the preoperative levels on five days after operation. Aspartate aminotransferase (AST) rapidly rised to the highest point andγ-glutamyl transpeptidase (GGT) slowly reached to the lowest point after two day postoperative. From two days after operation, AST was decreasing and GGT was increasing until reached preoperative levels. The trend of AST was similar with ALT and alkaline phosphatase (ALP) was similar with GGT in two groups. Con-clusion Postoperative liver function after selective right hepatectomy in patients older than 65 years was similar to that in patients who were younger than 40 years old.