肝硬化是影响child-pugh a级病人术后的独立因素word格式论文.docxVIP

中文摘要肝硬化是Child-PughA级病人肝切除的独立预后因素背景和目的：目前各种肝功能检测及评分方法的逐渐完善，新型器械的应用和外科医生经验的积累，肝脏安全性切除，已经取得了令人较满意的效果。但是肝癌合并肝硬化的切除后并发症和死亡率，仍然困扰着许多肝胆外科医生。即使是Child-PughA级病人，术后因肝功能衰竭，导致病人的死亡仍然较高。我们根据肝硬化形态学上的分级方法，进一步提高Child-PughA级病人的手术安全性。方法：收集华中科技大学同济医院肝脏外科2006年到2012年期间，共171例Child-PughA级肝癌合并肝硬化手术切除病例。术中将肝硬化形态，划分为呈现三个等级即轻度、中度、重度，分别64 例、73 例、34 例。分析其与相关术前肝功能指标、ICGR15min和MELD之间的联系，同时, 统计分析术后肝功能不全和并发症的高危因素。结果：不同程度的肝硬化与腹水、静脉曲张、血小板之间，有统计学意义。肝癌肝切除术后并发症和肝功能不全发生概率分别为32.2%、15.2%。单因素和多因素分析，均显示肝硬化(p0.05)是术后肝功能衰竭和并发症的有统计学意义。结论：Child-PughA级病人中，肝硬化是其术后并发症和肝功能不全发生的一个独立危险因素。[关键词]:肝功能；肝硬化；肝切除；肝功能不全。AbstractThe SeverityofCirrhosisisthe Significant RiskofPost-hepatectomy Complication inPatientswith Child-Pugh Grade ABackgroundandAim:Although,inrecentyears,duetotheperoperativeprecise assessementsofliverfunction,advancesinsurgericaltechniquesandtheincreasing experiencesofsurgeons,thehospitalmortalityratesinpatientswiththeprimaryhepatical carcinoma could be largely reduced，hepatic resection for HCC incirrhoticliverremainsachallengingtask，evenin patientswithChild-Pughgrade A,themortality andmorbidity arestillunsatisfactory.Thedifferentcirrhoticseverities arestratifiedinmild,morderate,severesubgrades.thepurposeofthisstudyweretoanalysetheresults of differentseverityofcirrhoticliver resection in thepastyearsand to proposesafestrategiesfor cirrhoticliver resection.Methods:BetweenJanuary2006andSeptember2012,inourcentre,171patients withChild-pughgradeAareidentifiedretrospectivelyanalysed,the clinicalcopathologicaldatasduringthepreoperative,interoperativeandpostoperative termsarecollected.thethesubgradesofcirrhoticseverityareidentifiedbefore makingadecsiononoperativestrategyinhepaticcacinoma,therelationshipbetween liverfunctionandthemorphologicalsubgradesincirroticseverityarestatically analysis,simultaneously,theriskfactorsforPHLFweresubjectedtounivariable and multivariable analysis.Reseult:Theseverityoflivercirrhosiscorrelateswithascites,varisandplatelets, whichhasastatisticalsignificance.Theincidencesofpost-hepate