中国实用外科杂志

中国实用外科杂志

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肝门部胆管癌术后胆红素一过性升高临床分析（附175例报告）

甘    伟a，俞文隆a，乔    亮b，何海冠c，胡舒阳d，卢军华c，张永杰a   

  1. 第二军医大学东方肝胆外科医院  a.胆道一科  b.特需一科  c.肝外四科  d.胆道二科，上海 200438
  • 出版日期:2016-02-01 发布日期:2016-01-29

  • Online:2016-02-01 Published:2016-01-29

摘要：

目的    探讨肝门部胆管癌术后胆红素的变化规律并分析其影响因素。方法    回顾性分析2009年1月至2012年12月第二军医大学东方肝胆外科医院175例肝门部胆管癌病人的临床资料，根据病人术后胆红素变化情况分为A组（胆红素逐渐下降，105例）和B组（胆红素一过性升高，70例），分析术后血清胆红素变化及其与各临床因素的关系。结果    A组术后血清胆红素逐渐下降2周左右恢复正常；B组术后血清胆红素先升高，4～5 d达到高峰后逐渐下降，恢复时间>2周。两组术前减黄、碱性磷酸酶（ALP）、谷氨酰转移酶（GGT）、CA19-9、输血、合并肝切除、肝硬化方面差异有统计学意义（P<0.05）；多因素 Logistic 回归分析显示，ALP（OR=0.996，95%CI 0.993～0.998）、CA19-9（OR=2.434，95%CI 1.177～5.037）、输血（OR=2.274，95%CI 1.088～4.753）和肝切除（OR=5.842，95%CI 1.473～23.171）、肝硬化（OR=2.690，95%CI 1.192～6.070）是术后胆红素一过性升高的独立影响因素。A、B组病人住院时间［（25.1±1.2）d vs. （38.7±2.0）d，t=-5.820］和并发症发生率（9.5% vs. 38.0%，χ2=22.948）差异有统计学意义（P<0.05）；而在术后存活时间方面，组间差异无统计学意义（中位生存期：30个月 vs. 26个月，χ2 =0.562，P=0.453）。结论    ALP、CA19-9、输血和肝切除、肝硬化是肝门部胆管癌病人术后胆红素一过性升高的独立影响因素，而胆红素一过性升高可能增加术后并发症发生率，延长住院时间，但不影响病人存活时间。

关键词: 肝门部胆管癌, 胆红素

Abstract:

Transient rise of postoperative bilirubin for hilar cholangiocarcinoma: A report of 175 cases        GAN Wei*，YU Wen-long，QIAO Liang，et al. *1st Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital，the Second Military Medical University, Shanghai 200438，China
Corresponding author：ZHANG Yong-jie，E-mail：yjoy005@sina.com
Abstract    Objective    To explore the change rule of postoperative bilirubin for hilar cholangiocarcinoma，and analysis the influence factors of postoperative serum bilirubin elevation. Methods    The clinical data of 175 cases of hilar cholangiocarcinoma admitted from January 2009 to December 2012 in Eastern Hepatobiliary Surgery Hospictal were analyzed retropectively. All the cases were divided into groupA (105 cases of bilirubin declined gradually) and group B (70 cases of bilirubin rising trasiently). The influence factors of postoperative serum bilirubin elevation were analyzed by t-test chi-square test Fisher exact probability test and Keplan-Meier method. Results    The postoperative serum bilirubin gradually declined to the normal range in 2 weeks in group A，whereas it reached a peak at the first 4-5 days then declined gradually in group B and still can not return to normal range in two weeks. According to the single factor analysis, blood transfusion, hepatectomy, hepatic liver cirrhosis or not, CA19-9, ALP, preoperative biliary drainage and GGT had statistical differences between two groups（P<0.05）. Multivariate Logistic analysis showed that ALP（OR=0.996，95%CI 0.993-0.998）, CA19-9（OR=2.434，95%CI 1.177-5.037）, blood transfusion (OR=2.274, 95%CI 1.088-4.753), hepatectomy(OR=5.842，95%CI 1.473-23.171） and hepatic liver cirrhosis（OR=2.690，95%CI 1.192-6.070）were the independent risk factors for the changes of postoperative bilirubin. The hospital stays [(25.1±1.2)d vs. (38.7±2.0)d，t=-5.820] and postoperative complications incidence（9.5% vs. 38.0%, χ2=22.948）had statistical differences（P<0.05）. There was no statistical difference in the prognosis between two groups (median survival time:30 months vs. 26 months, χ2=0.562，P=0.453). Conclusion  ALP, CA19-9, the blood transfusion, hepatectomy and liver cirrhosis were the independent influence factors for the transient rise of postoperative bilirubin. The transient rise of post operative bilirubin may increase the risk of postoperative complications,extend hospital stays，but not shorter the life expectancy.

Key words: hilar cholangiocarcinoma, bilirubin