腹腔镜肝叶切除术常见并发症的危险因素分析及临床处理

doi:10.3969/j.issn.1672-5069.2017.02.022

摘要/Abstract

摘要： 目的分析腹腔镜肝叶切除术常见并发症发生的危险因素和提出对应的临床处理措施。方法回顾性分析2011年1月～2014年12月我院收治的行腹腔镜肝叶切除术患者131例，按照性别、年龄、ASA分级（美国麻醉医师协会关于麻醉前患者体质状况和对手术危险性分类标准)、Child-Pugh分级、体质指数（BMI）、甲胎蛋白（AFP）、白蛋白（ALB）、肿瘤直径、出血量、是否输血、腹部手术史、中转开腹和手术时间为条件进行分类，对以上经单因素分析后得出有统计学差异的因素再行多因素二分类Logistic 回归分析，得出腹腔镜肝叶切除术常见并发症发生的危险因素。结果在131例患者中出现术后并发症30例（22.9%），其中肺部感染12例（9.2%）、胆瘘5例（3.8%）、腹腔积液6例（4.6%）、胸腔积液4例（3.1%）、气体栓塞2（1.5%）、休克1例（0.8%）；经单因素分析，结果显示年龄<60岁的患者并发症发生率为15.5%，显著低于年龄≥60岁患者的31.7%（P＜0.05），ASA分级为II级的患者并发症发生率为16.2%，显著低于III级患者的30.2%（P＜0.05），Child A级患者并发症为14.3%，显著低于B级患者的32.8%（P＜0.05），AFP水平<400μg//L的患者并发症为15.4%，显著低于≥400μg//L患者的33.9%（P＜0.05），出血量<800 ml的患者并发症为15.1%，显著低于≥800 ml患者的37.8%（P＜0.05），有中转开腹的患者并发症为58.3%，显著高于未中转开腹患者的19.3%（P＜0.05），手术时间<3 h的患者并发症为14.6%，显著低于≥ 3h 患者的36.7%（P＜0.05）；经二分类Logistic回归分析，结果显示年龄、Child分级、出血量、中转开腹和手术时间五个因素为主要的影响因素（P＜0.05）。结论对于高龄、Child评分高、出血量大、手术时间长和中转开腹患者行腹腔镜肝叶切除术治疗，需注意并发症的防治。

关键词: 腹腔镜肝叶切除术, 原发性肝癌, 肝良性肿瘤, 并发症, 危险因素

Abstract: Objective To investigate the risk factors of common complications occurrence in patients with malignant and benign hepatic disease after laparoscopic hepatectomy.Methods 131 patients with malignant and benign hepatic disease receiving laparoscopic hepatectomy between January 2011 and December 2014 were recruited in this study. The patients were classified according to gender，age，ASA classification，Child-Pugh class， body mass index （BMI），alpha-fetoprotein（AFP），albumin（ALB），tumor size，blood loss，blood transfusion， abdominal surgery history，laparotomy and surgery time to analyze the risk factors by univariate analysis and by multivariate Logistic analysis.Results Out of 131 patients，30（22.9%） had complications after laparoscopic hepatectomy，including pneumonia in 12 （9.2%），bile leakage in 5（3.8%），ascites in 6（4.6%），pleural effusion in 4（3.1%），gas embolism in 2（1.5%）and shock in 1（0.8%）；The univariate analysis showed that the complications occurrence rate in patients younger than 60 years，ASA classification grade Ⅱ，Child-Pugh class A，lower AFP levels，less bleeding，without laparotomy and shorter operative time were lower than in their opposite partners，and the differences were all significant （P<0.05）；Multivariate Logistic regression analysis showed that age，Child-Pugh class， amount of bleeding，laparotomy and surgical time were independent risk factors for complications occurrence in patients after laparoscopic hepatectomy.Conclusion It must be emphasized that the age，Child-Pugh class，bleeding，laparotomy and surgical time should be taken into consideration to prevent common complications occurrence in patients with hepatic tumors after laparoscopic hepatectomy.

Key words: Laparoscopic hepatectomy, Hepatoma, Complications, Risk factors

江现强，俞渊，陆世锋. 腹腔镜肝叶切除术常见并发症的危险因素分析及临床处理[J]. 实用肝脏病杂志, 2017, 20(2): 215-218.

Jiang Xianqiang，Yu Yuan，Lu Shifeng.. Risk factors of common complications occurrence in patients with malignant and benign hepatic disease after laparoscopic hepatectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(2): 215-218.

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