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肝细胞癌肝切除术后腹腔内感染的危险因素及长期预后

Risk factors and long-term outcome for postoperative intra-abdominal infection after hepatectomy for hepatocellular carcinoma.

作者信息

Tang Haowen, Lu Wenping, Yang Zhanyu, Jiang Kai, Chen Yongliang, Lu Shichun, Dong Jiahong

机构信息

Institute of Hepatobiliary Surgery, Chinese PLA General Hospital Center for Hepatopancreatobiliary Diseases, Beijing Tsinghua Changgung Hospital, Tsinghua University Medical Center, Changping, Beijing, China.

出版信息

Medicine (Baltimore). 2017 Apr;96(17):e6795. doi: 10.1097/MD.0000000000006795.

DOI:10.1097/MD.0000000000006795
PMID:28445320
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5413285/
Abstract

Intra-abdominal infection (IAI) after hepatectomy is an important morbidity. Identification of risk factors that could be avoided in the perioperative period may reduce the prevalence of IAI after hepatectomy for hepatocelluar carcinoma (HCC).Between January 1995 and December 2009, all patients with HCC who underwent curative liver resection were evaluated retrospectively. Long-term outcomes were compared in IAI patients and non-IAI patients after hepatectomy. Preoperative, intraoperative, and tumor-related factors that could be independent factors for postoperative IAI were identified.Of 622 patients with HCC, 24 patients (3.9%) had IAI after hepatectomy. Both median survival and survival of patients with postoperative IAI were shorter than those for non-IAI patients (P < .05). Upon univariate analysis followed by multivariate analyses, three independent predictors for IAI were identified: weight loss (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.17-9.11; P = .024), liver cirrhosis (0.28, 0.12-0.67, .004), and operative time >300 minutes (3.44, 1.46-8.12, .005).IAI after hepatectomy affects outcome adversely. Preoperative weight loss, liver cirrhosis, and operative time >300 minutes are independent predictors of postoperative IAI.

摘要

肝切除术后腹腔内感染（IAI）是一种重要的并发症。识别围手术期可避免的危险因素可能会降低肝细胞癌（HCC）肝切除术后IAI的发生率。1995年1月至2009年12月，对所有接受根治性肝切除术的HCC患者进行回顾性评估。比较肝切除术后IAI患者和非IAI患者的长期预后。确定术前、术中和肿瘤相关因素中可能是术后IAI独立因素的因素。在622例HCC患者中，24例（3.9%）肝切除术后发生IAI。术后IAI患者的中位生存期和生存率均短于非IAI患者（P<0.05）。单因素分析后进行多因素分析，确定了IAI的三个独立预测因素：体重减轻（比值比[OR]，3.27；95%置信区间[CI]，1.17-9.11；P=0.024）、肝硬化（0.28，0.12-0.67，0.004）和手术时间>300分钟（3.44，1.46-8.12，0.005）。肝切除术后IAI对预后有不利影响。术前体重减轻、肝硬化和手术时间>300分钟是术后IAI的独立预测因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e15a/5413285/262c5ffef62d/medi-96-e6795-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e15a/5413285/262c5ffef62d/medi-96-e6795-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e15a/5413285/262c5ffef62d/medi-96-e6795-g001.jpg

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