中国实用外科杂志

中国实用外科杂志

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肝门部胆管癌行大范围肝切除术后并发症危险因素分析

尹    磊1a，阮    祥1a，张协群2，袁    波3，俞文隆1a，傅晓辉1a，姜小清1c，张宝华1b，张永杰1a   

  1. 1海军军医大学附属东方肝胆外科医院 a.胆道二科b.腹腔镜科 c.胆道一科，上海200438；2安康市中心医院肝胆外科，陕西安康725000；3中国人民解放军海军特色医学中心肝胆外科，上海200052
  • 出版日期:2019-09-01 发布日期:2019-09-12

  • Online:2019-09-01 Published:2019-09-12

摘要：

目的    分析行大范围肝切除术的肝门部胆管癌病人临床特点与术后并发症发生率之间的关系。方法  对2010年1月至2017年10月收治的335例行大范围肝切除术的肝门部胆管癌病人的临床特点和术后并发症进行回顾性分析。根据并发症发生的严重程度分为两组：低Clavien-Dindo分级组（LCD）及高Clavien-Dindo分级组（HCD），进行统计分析。结果    335例行大范围肝切除术的肝门部胆管癌病人，LCD组219例，HCD组116例。国际标准化比值（INR）升高、Bismuth Ⅲa/Ⅳ型、右半肝/扩大右半肝/右三叶切除是发生术后严重并发症的高危因素。术前减黄组术后严重并发症发生率34.18%（67/196），与未减黄组的35.25%（49/139）差异无统计学意义（P=0.8396）。剂量反应曲线及Logistic回归提示，胆红素＜140 μmol/L病人与胆红素≥140 μmol/L病人术后并发症风险存在统计学差异（OR=1.917，95％CI 1.147～3.203，P=0.0130）。进行统计学校正后，统计学关联仍然存在，其中胆红素＜140 μmol/L组，减黄率59.2%（151/255），胆红素≥140 μmol/L组，减黄率56.3%（45/80）例。结论    在联合大范围肝切除的HCCA病人中，对于TB≥140 μmol/L的病人，术前应常规行减黄治疗。特别是对于右半肝切除、术前高INR的病人，更应引起足够重视。减黄方式对术后总体并发症情况无显著影响，可根据病情需要灵活选择不同的减黄方式。

关键词: 肝门部胆管癌, 大范围肝切除, Clavien-Dindo分级, 血清总胆红素

Abstract:

Analysis of risk factors for postoperative complications of hepatic hilar cholangiocarcinoma after extensive hepatectomy        YIN Lei*,RUAN Xiang，ZHANG Xie-qun，et al. *Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University,Shanghai 200438,China
Corresponding author：ZHANG Yong-jie，E-mail：63834066@qq.com
YIN Lei,RUAN Xiang and ZHANG Xie-qun are the first authors who contributed equally to the article
Abstract    Objective    To analyze the relationship between clinical characteristics and postoperative complications in patients with hilar cholangiocarcinoma （HCCA） who underwent major liver resection （MLR）. Methods    Clinical characteristics and postoperative complications of 335 patients with HCCA who underwent MLR from January 2010 to October 2017 were retrospectively analyzed. According to the severity of complications，the patients were divided into two groups：low clavien-dindo group （LCD） and high clavien-dindo group （HCD）.Results    There were 219 patients in LCD group and 116 patients in HCD group. Elevated INR，Bismuth Ⅲa/Ⅳ type and the right liver/expanding right/right trilobites resection were high risk factors of postoperative serious complications. The incidence of severe postoperative complications in the group with preoperative biliary drainage was 34.18% （67/196），which was not statistically significant different from that in the group without preoperative biliary drainage [35.25% （49/139）, P=0.8396]. The dose-response curve and Logistic regression indicated that there was a statistical difference in postoperative complication risk between patients with total bilirubin （TB） ＜140 mol/L and patients with TB≥140 mol/L （OR=1.917，95%CI 1.147~3.203，P=0.0130）. After statistical correction，the statistical correlation remained，among which，the preoperative biliary drainage rate was 59.2% （151/255） in the group with TB＜140 mol/L，and 56.3% （45/80） in the group with TB≥140 mol/L. Conclusion  In patients with HCCA combined with MLR，patients with TB ≥ 140 mol/L should be routinely treated with preoperative biliary drainage. Especially for the right liver resection，preoperative high INR patients，more attention should be paid to. Methods of preoperative biliary drainage have no significant effect on the overall postoperative complications and can be flexibly selected according to the needs of the disease.

Key words: hilar cholangiocarcinoma, major liver resection, Clavien - Dindo classification, total serum bilirubin