摘要
目的 探讨腹腔镜解剖性与非解剖性肝切除肝细胞癌患者的术后早期营养状态,分析术后感染的影响因素。方法 将60例腹腔镜肝切除肝细胞癌患者根据手术方法的不同分为对照组(n=27,行腹腔镜非解剖性肝切除术)和观察组(n=33,行腹腔镜解剖性肝切除术),比较两组患者的围手术期指标、营养状态[预后营养指数(PNI)、那不勒斯预后评分(NPS)]。腹腔镜肝切除肝细胞癌患者术后感染的影响因素采用多因素Logistic回归分析。结果 两组患者手术时间、术中出血量比较,差异均无统计学意义(P﹥0.05);观察组患者住院时间明显短于对照组,差异有统计学意义(P﹤0.01)。术后,不同Child-Pugh肝功能分级两组肝细胞癌患者PNI、NPS均低于本组术前,观察组患者PNI、NPS均高于对照组,差异均有统计学意义(P﹤0.05)。60例肝细胞癌患者中,腹腔镜肝切除术后感染10例,未发生感染50例,分别作为感染组和未感染组,感染组与未感染组患者年龄、Child-Pugh肝功能分级、美国麻醉医师协会(ASA)分级、合并基础疾病情况、术前PNI及术前NPS比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,Child-Pugh肝功能分级为B级、术前PNI﹤51、术前NPS﹤3分均是腹腔镜肝切除肝细胞癌患者术后感染的独立危险因素(P﹤0.05)。结论 腹腔镜解剖性肝切除术对肝细胞癌患者术后早期营养状态的影响较小,有利于患者的术后恢复。Child-Pugh肝功能分级为B级、术前PNI﹤51、术前NPS﹤3分均是腹腔镜肝切除肝细胞癌患者术后感染的独立危险因素。
Objective To explore the postoperative early nutritional status in patients with hepatocellular carcinoma undergoing laparoscopic anatomical and non-anatomical hepatectomy,and analyze the influencing factors of postoperative infection.Method A total of 60 patients with hepatocellular carcinoma who underwent laparoscopic hepatectomy were divided into control group(n=27,underwent laparoscopic non-anatomical hepatectomy)and observation group(n=33,underwent laparoscopic anatomical hepatectomy)according to different surgical methods.The perioperative indicators and nutritional status[prognostic nutritional index(PNI),Naples prognostic score(NPS)]were compared between the two groups.Multivariate Logistic regression analysis was used to investigate the influencing factors of postoperative infection in patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy.Result There were no statistically significant differences in surgery time and intraoperative bleeding between the two groups(P>0.05).The hospitalization time in observation group was significantly shorter than that in control group,and the difference was statistically sig-nificant(P<0.01).After surgery,the PNI and NPS of two groups of hepatocellular carcinoma patients with different Child-Pugh liver function grading were lower than those before surgery,the PNI and NPS of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).Among 60 patients with hepato-cellular carcinoma undergoing laparoscopic hepatectomy,there were 10 cases of infection and 50 cases without infection after laparoscopic hepatectomy,which were divided into the infection group and the non-infection group.There were statistically significant differences in age,Child-Pugh liver function grading,American Society of Anesthesiologists(ASA)grading,comorbidities,preoperative PNI,and preoperative NPS between infection group and non-infection group(P<0.05).Multivariate Logistic regression analysis showed that Child-Pugh liver function grading B,preoperative PNI<51,and preoperative NPS<3 scores were independent risk factors for postoperative infection in patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy(P<0.05).Conclusion Laparoscopic anatomical hepatectomy has a relatively small impact on postoperative early nutritional status in patients with hepatocellular carcinoma,which is beneficial for their postoperative recovery.Child-Pugh liver function grading B,preoperative PNI<51,and preoperative NPS<3 scores are independent risk factors for postoperative infection in patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy.
作者
黎焕
张昱君
曾三平
曾志峰
LI Huan;ZHANG Yujun;ZENG Sanping;ZENG Zhifeng(Department of Hepatobiliary Surgery,Xinyu People'sHospital,Xinyu 338000,Jiangxi,China)
出处
《癌症进展》
2024年第21期2387-2391,共5页
Oncology Progress
基金
江西省卫生健康委科技计划项目(20204504)。
关键词
肝细胞癌
腹腔镜解剖性肝切除术
营养状态
术后感染
hepatocellular carcinoma
laparoscopic anatomical hepatectomy
nutritional status
postoperative infection
