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目的分析肝癌合并肝硬化大块肝切除的风险。方法回顾性分析近8年我院90例肝癌合并肝硬化大块切除病例。结果乙肝感染率81%,肝功能A级55.6%,B级40%,C级4.4%。轻度肝硬化44.4%,中度46.7%,重度8.9%。肝癌大小(8.5!4.0)cm,手术时间为(188!89)min,失血量(1281!1831)mL,输血量(1109!1213)mL。术后总并发症为24%,严重并发症17.8%,肝功能衰竭及肝功不全发生率8.9%。手术死亡率为6.7%。单变量分析示术前AST、肝功能、手术时间及失血量为肝功能衰竭发生的独立因素,多变量分析提示手术时间及肝功能为肝功能衰竭发生的独立危险因素(P<0.01,P<0.05)。结论术前肝功C级应避免手术切除。术中缩短手术时间对预防肝功能衰竭起关键作用。
Objective To analyze the risk of hepatocellular carcinoma (HCC) with liver resection. Methods Retrospective analysis of 90 cases of liver cancer with liver cirrhosis mass resection in our hospital in recent 8 years. Results The infection rate of hepatitis B was 81%, grade A was 55.6%, grade B was 40%, and grade C was 4.4%. Mild cirrhosis 44.4%, moderate 46.7%, severe 8.9%. The size of liver cancer was (8.5 4.0) cm. The operation time was (188.89) min, blood loss (1281-1831) mL and blood transfusion volume (1109-1213) mL. Total postoperative complications were 24%, severe complications 17.8%, liver failure and hepatic insufficiency 8.9%. Surgical mortality was 6.7%. Univariate analysis showed that preoperative AST, liver function, operation time and blood loss were independent factors of liver failure. Multivariate analysis suggested that operation time and liver function were independent risk factors of liver failure (P <0.01, P < 0.05). Conclusion Preoperative liver function C level should avoid surgical resection. Surgery to shorten the operation time plays a key role in preventing liver failure.