肝癌术后急性肝能衰竭影响因素分析.pdfVIP

目 录 中文摘要 ···················································3 英文摘要 ···················································4 引 言 ····················································6 正 文 ····················································7 1.临床资料 ·················································7 1.1 研究对象 ·················································7 1.2 入组标准 ·················································8 1.3 一般资料 ·················································8 1.4 统计学方法 ···············································9 2.结果 ·····················································9 3.讨 论 ················································11 4.存在的问题和展望 ······································13 结 论 ··················································14 参考文献 ··················································14 附 录 ··················································17 综 述 ··················································18 致 谢 ··················································29 攻读学位期间发表的学术论文目录 ·······················30 作者声明 ··················································31 个人简历 ··················································32 - 2 - 中 文 摘 要 目 的：探讨原发性肝癌术后急性肝功能衰竭的术前和术中影 响因素。 方 法：2007 年1 月-2009 年12 月在广西中医学院第一附属医 院行肝癌手术34 例，分别统计患者的性别、年龄、基础疾病、术前肝功 能、肝癌的大小、癌栓及 （或）胆栓、术中出血量、手术切除范围等方 面的指标，运用二元Logistic 多因素回归分析来判断与术后肝功能衰竭 的关系。 结 果： 患者中术后发生肝功能衰竭的有 5 例 (5/34) 。 Child-Pugh B 级患者术后出现肝功能衰竭 3 例(3/8)，Chlid-Pugh A 级 患者术后出现肝功能衰竭2 例(2/26)；术中出血量≥1000ml 的患者术后 出现肝功能衰竭2 例(2/11)，术中出血量1000ml 的患者3 例(3/23)；半 肝手术患者术后出现肝功能衰竭 1 例(1/5)，行其他手术患者术后出现肝 功能衰竭 4 例(4/29)；合并癌栓及 （或）胆栓的患者 3 例（3/9），无癌 栓及 （或）胆栓的2 例（2/25 ）。经观察分析：Child-Pugh B、术中出血 量≥1000ml、半肝手术、合并癌栓及 （或）胆栓患者术后肝功能衰竭的 发生率高于其他患者，而性别、年龄、基础疾病、肝癌的大小与术后肝 功能衰竭发生无影响。5 例肝功能衰竭病人中有1 例经抢救无效死亡。 结 论：术前肝功能Child-Pugh 分级是术后急性肝功能衰竭的 独立影响因素，出血量≥1000ml、半肝切除、癌栓及 （或）胆栓是肝癌 术后肝功能衰竭重要危险因素。术