CAJ | 학술논문

目的：探讨分析肝癌伴胆管癌栓患者术后发生肝功能衰竭的影响因素。方法将108例肝癌伴胆管癌栓患者，按照肝癌切除术后是否发生肝功能衰竭，分为未发生肝功能衰竭组（A组）与发生肝功能衰竭组（B组），采用Lo-gistic二元回归进行单因素分析，并将单因素分析结果具有统计学意义的影响因素，纳入Logistic多元回归模型，再行多因素分析。结果单因素分析发现：手术前总胆红素（TBil）、白蛋白（Alb）、前白蛋白（Pre-Alb）、白球比值（A/G），癌栓位置以及手术后剩余肝脏体积占全肝脏体积的比率等，与患者术后发生肝功能衰竭显著相关（P均＜0．05）；经多因素分析发现，术后剩余肝脏体积占全肝脏体积的比率＜50％、手术前TBil＞256．5μmol/L、术前白球比值≤1．3，均是造成该类患者术后发生肝功能衰竭的独立危险因素（P均＜0．05）。结论肝癌伴胆管癌栓患者术后是否会发生肝功能衰竭，与手术前TBil水平、术后剩余肝脏体积占全肝脏体积的比率以及术前白球比值等因素有密切关系。手术前后减少与控制各类影响因素，才能有利于控制患者术后肝功能衰竭的发生。
목적：탐토분석간암반담관암전환자술후발생간공능쇠갈적영향인소。방법장108례간암반담관암전환자，안조간암절제술후시부발생간공능쇠갈，분위미발생간공능쇠갈조（A조）여발생간공능쇠갈조（B조），채용Lo-gistic이원회귀진행단인소분석，병장단인소분석결과구유통계학의의적영향인소，납입Logistic다원회귀모형，재행다인소분석。결과단인소분석발현：수술전총담홍소（TBil）、백단백（Alb）、전백단백（Pre-Alb）、백구비치（A/G），암전위치이급수술후잉여간장체적점전간장체적적비솔등，여환자술후발생간공능쇠갈현저상관（P균＜0．05）；경다인소분석발현，술후잉여간장체적점전간장체적적비솔＜50％、수술전TBil＞256．5μmol/L、술전백구비치≤1．3，균시조성해류환자술후발생간공능쇠갈적독립위험인소（P균＜0．05）。결론간암반담관암전환자술후시부회발생간공능쇠갈，여수술전TBil수평、술후잉여간장체적점전간장체적적비솔이급술전백구비치등인소유밀절관계。수술전후감소여공제각류영향인소，재능유리우공제환자술후간공능쇠갈적발생。
Objective To investigate the influence factors of post -operative hepatic failure of Hepatocellular carcinoma ( HCC) patients with bile duct thrombi .Methods 108 cases of HCC patients with bile duct thrombi were divided into without liver failure group( group A) and liver failure group(group B ).Logistic binary regression was used to perform single factor anal-ysis,and the statistically significant influencing factors were analyzed by multivariate analysis using multi -factor logistic regression model.Results Single factor analysis showed that preoperative total bilirubin ,albumin,prealbumin,albumin/globulin ratio,dis-tribution of tumor thrombus and postoperative residual liver volume /total liver volume ratio were correlated with the postoperative liver failure in HCC patients with bile duct tumor thrombus (all P<0.05).Multi-factor analysis showed that postoperative residual liver volume/total liver volume ratio<50%,preoperative total bilirubin >256.5 umol/L and albumin/globulin ratio≤1.3 were independent risk factors of postoperative liver failur (allP<0.05).Conclusion The occurrence of post-operative hepatic failure in Hepatocellular carcinoma ( HCC) patients with bile duct thrombi is closely related with preoperative total bilirubin level ,post-operative residual liver volume/total liver volume ratio ,preoperative albumin/globulin ratio .Reduce and control all kinds of influ-encing factors before and after surgery could help control the occurrence of postoperative liver failure .