老年HCC患者肝切除术后大量腹水形成的相关因素分析及治疗对策

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摘要目的探讨影响老年原发性肝细胞癌患者（HCC）肝切除术后大量腹水形成的原因及防治措施。方法回顾性分析我院2013年1月～2016年1月收治的HCC并行肝切除的102例老年患者的临床资料，根据术后腹水生成量分为大量腹水组和非大量腹水组，分析并筛选肝切除术后大量腹水形成的相关危险因素。结果102例中19例发生大量腹水，单因素分析显示，术前低蛋白血症，血小板计数，术中出血量以及合并肝硬化、门静脉癌栓与术后大量腹水形成有关（P＜0.05）；多因素Logistic分析表明，术前低蛋白血症、术前血小板减少（＜100×109/L）及术中出血量≥600 ml是术后发生大量腹水的独立危险因素（OR=2.172，2.430，3.985，P＜0.05）。大量腹水组与非大量腹水组比较，其术后拔管时间、住院时间等术后观察指标差异有统计学意义（P＜0.05）。结论分析老年HCC患者行肝切除术后大量腹水形成的相关因素，有助于围术期对腹水形成的相关因素积极防范并处理，从而降低术后发生率并提高患者预后。

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	徐建
	李敬东

关键词 ：原发性肝细胞癌, 腹水, 危险因素, 回归分析

Abstract：Objective To explore the reason and preventing measures of mass ascites in elderly patients with primary hepatocellular carcinoma(HCC)after hepatectomy.Methods Clinical data from 102 elderly HCC patients undergone hepatectomy admitted into our hospital from January 2013 to January 2016 were retrospectively analyzed.According to volume of ascites after surgery,they were divided into mass ascites group and non-mass ascites group.The relevant risk factors of leading to mass ascites after hepatectomy were analyzed and screened.Results There were 19 out of 102 cases occurred with mass ascites.Univariate analysis showed that pre-operative hypoalbuminemia and platelet count,intraoperative blood loss and combination of cirrhosis and portal vein tumor thrombus were associated with postoperative mass ascites(P＜0.05).Multivariate logistic analysis displayed that preoperative hypoproteinemia and thrombocytopenia(＜100× 109/L),and intraoperative blood loss≥600 ml was independent risk factors for postoperative mass ascites(OR= 2.172,2.430,3.985,P＜0.05).Compared with non-mass ascites group,the postoperative observational indexes including extubation time and hospital stay were displayed statistical differences(P＜0.05).Conclusion Analyzing the related factors on the generation of mass ascites in elderly HCC patients after hepatectomy is beneficial to positively prevent and tackle the relevant factors leading to ascites generation during perioperative period,so as to reduce the postoperative incidence and improve patients′prognosis.

Key words： Primary hepatocellular carcinoma Ascites Risk factors Regression analysis

基金资助:四川省教育厅青年创新团队（16TD0025）

通讯作者: 李敬东，教授，硕士生导师

作者简介: 徐建（1986-），男，医学硕士，住院医师，研究方向：肝胆胰脾疾病的基础与临床

引用本文:

徐建;李敬东. 老年HCC患者肝切除术后大量腹水形成的相关因素分析及治疗对策[J]. 中国当代医药, 2017, 24(10): 19-22转26.
XU Jian；LI Jing-dong. Related factors analysis of mass ascites in elderly patients with HCC after hepatectomy and treatment strategies. 中国当代医药, 2017, 24(10): 19-22转26.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2017/V24/I10/19

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