Wang He, Lu Shi-Chun, He Lei, Dong Jia-Hong
Department of Hepatobiliary Surgery, The General Hospital of the People's Liberation army Beijing Tsinghua Changgung Hospital, Beijing, China.
Medicine (Baltimore). 2018 Feb;97(8):e9963. doi: 10.1097/MD.0000000000009963.
Liver failure remains as the most common complication and cause of death after hepatectomy, and continues to be a challenge for doctors.t test and χ test were used for single factor analysis of data-related variables, then results were introduced into the model to undergo the multiple factors logistic regression analysis. Pearson correlation analysis was performed for related postoperative indexes, and a diagnostic evaluation was performed using the receiver operating characteristic (ROC) of postoperative indexes.Differences in age, body mass index (BMI), portal vein hypertension, bile duct cancer, total bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), operation time, cumulative portal vein occlusion time, intraoperative blood volume, residual liver volume (RLV)/entire live rvolume, ascites volume at postoperative day (POD)3, supplemental albumin amount at POD3, hospitalization time after operation, and the prothrombin activity (PTA) were statistically significant. Furthermore, there were significant differences in total bilirubin and the supplemental albumin amount at POD3. ROC analysis of the average PTA, albumin amounts, ascites volume at POD3, and their combined diagnosis were performed, which had diagnostic value for postoperative liver failure (area under the curve (AUC): 0.895, AUC: 0.798, AUC: 0.775, and AUC: 0.903).Preoperative total bilirubin level and the supplemental albumin amount at POD3 were independent risk factors. PTA can be used as the index of postoperative liver failure, and the combined diagnosis of the indexes can improve the early prediction of postoperative liver failure.
肝衰竭仍然是肝切除术后最常见的并发症和死亡原因，并且仍然是医生面临的一项挑战。采用t检验和χ检验对数据相关变量进行单因素分析，然后将结果纳入模型进行多因素逻辑回归分析。对相关术后指标进行Pearson相关性分析，并使用术后指标的受试者工作特征曲线（ROC）进行诊断评估。年龄、体重指数（BMI）、门静脉高压、胆管癌、总胆红素、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、手术时间、累计门静脉阻断时间、术中出血量、残余肝体积（RLV）/全肝体积、术后第3天（POD3）的腹水量、POD3时补充白蛋白量、术后住院时间以及凝血酶原活动度（PTA）的差异具有统计学意义。此外，总胆红素和POD3时补充白蛋白量存在显著差异。对平均PTA、白蛋白量、POD3时腹水量及其联合诊断进行ROC分析，其对术后肝衰竭具有诊断价值（曲线下面积（AUC）：0.895、AUC：0.798、AUC：0.775和AUC：0.903）。术前总胆红素水平和POD3时补充白蛋白量是独立危险因素。PTA可作为术后肝衰竭的指标，指标的联合诊断可提高术后肝衰竭的早期预测能力。
