Lv Y, Liu C, Wei T, Zhang J-F, Liu X-M, Zhang X-F
Department of Hepatobiliary Surgery, 1st Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, PR China; Institute of Advanced Surgical Technology and Engineering, 1st Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, PR China.
Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, PR China.
Eur J Surg Oncol. 2015 Apr;41(4):513-9. doi: 10.1016/j.ejso.2015.01.015. Epub 2015 Jan 26.
Cigarette smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. The objective of this study was to investigate whether preoperative smoking has any impact on early morbidity after liver resection for hepatocellular carcinoma (HCC).
Data of 425 consecutive patients undergoing partial hepatectomy for HCC was retrospectively reviewed. Smoking and drinking habits, biochemical tests, tumor status, operation data, and any postoperative complications occurring before discharge from the hospital were documented. The risk factors promoting postoperative complications were analyzed by univariate and multivariate methods.
The overall morbidity rate was 40% (170 of 425). 166 patients were current smokers (39%). By multivariate analysis, liver cirrhosis (Risk Ratio (RR) 4.0, 95% confidence interval (CI) 2.0-8.0), smoking status (RR 3.0, 95% CI 1.7-5.1), PY of smoking (RR 1.3, 95% CI 1.1-1.9), preoperative platelet count (RR 1.6, 95% CI 1.4-2.0) and major hepatectomy (RR 1.4, 95% CI 1.1-1.8) were independent risk factors of postoperative morbidity (all p < 0.05). Liver failure, bile leakage, intractable ascites, chest and wound infection were more frequently occurred in smokers than non-smokers. Current smokers had higher postoperative morbidity than non- & former smokers in patients with normal liver and those with liver cirrhosis (p = 0.047 and p < 0.001, respectively).
Cigarette smoking is an independent risk factor for the development of liver-related and infectious complications in patients undergoing partial hepatectomy for HCC, especially in those with liver cirrhosis.
吸烟是 major surgical procedures 术后发生肺部并发症的重要危险因素。本研究的目的是调查术前吸烟是否对肝细胞癌（HCC）肝切除术后的早期发病率有任何影响。
回顾性分析 425 例连续接受 HCC 部分肝切除术患者的数据。记录吸烟和饮酒习惯、生化检查、肿瘤状况、手术数据以及出院前发生的任何术后并发症。采用单因素和多因素方法分析促进术后并发症的危险因素。
总发病率为 40%（425 例中的 170 例）。166 例患者为当前吸烟者（39%）。多因素分析显示，肝硬化（风险比（RR）4.0，95%置信区间（CI）2.0 - 8.0）、吸烟状态（RR 3.0，95%CI 1.7 - 5.1）、吸烟包年数（RR 1.3，95%CI 1.1 - 1.9）、术前血小板计数（RR 1.6，95%CI 1.4 - 2.0）和肝大部切除术（RR 1.4，95%CI 1.1 - 1.8）是术后发病的独立危险因素（均 p < 0.05）。吸烟者比非吸烟者更频繁发生肝功能衰竭、胆漏、顽固性腹水、胸部和伤口感染。在肝功能正常和肝硬化患者中，当前吸烟者的术后发病率高于非吸烟者和既往吸烟者（分别为 p = 0.047 和 p < 0.001）。
吸烟是接受 HCC 部分肝切除术患者发生肝脏相关和感染性并发症的独立危险因素，尤其是在肝硬化患者中。
