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肝切除术治疗肝细胞癌后肝再生的影响因素分析
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Abstract:
目的：探讨肝切除术治疗肝细胞癌后肝再生的影响因素。方法：选取青岛大学附属医院肝胆胰外科2014年1月~2020年12月因肝细胞癌行解剖性肝切除的患者，97例具有术后3天、1月CT检查及完整临床资料的患者被纳入研究。采用Hisense CAS根据患者的CT检查进行肝脏三维重建及模拟切除，测量残余肝体积及肝切除术后1月的肝脏体积，计算术后1月残余肝体积的再生率。探讨肝切除术后影响肝脏再生的显著因素。结果：97例肝细胞癌肝切除患者中左半肝切除术患者31例，右半肝切除术患者66例。所有患者术后1月中位肝再生率为17.6%。其中右半肝切除组术后1月中位肝再生率为20.29%；左半肝切除组术后1月中位肝再生率为12.2%。单因素分析显示年龄(P < 0.05)，性别(P < 0.05)、饮酒史(P < 0.05)、肝硬化程度(P < 0.05)、标准残肝体积(P < 0.001)在高再生组和低再生组之间差异具有统计学意义(P < 0.05)。多因素Logistic回归分析显示肝硬化程度(OR = 0.294, 95%CI: 0.100~0.871, P = 0.027)和SRLV (OR = 0.989, 95%CI: 0.983~0.994, P < 0.001)是影响肝胆肿瘤肝切除术后肝再生的独立危险因素。
Objective: To explore the influencing factors of liver regeneration after hepatectomy for hepatocel-lular carcinoma. Methods: A total of 97 patients who underwent anatomical hepatectomy for hepa-tocellular carcinoma from January 2014 to December 2020 in the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, were included in the study, with CT scans at 3 days and 1 month after surgery and complete clinical follow-up data. Hisense CAS was used to perform three-dimensional liver reconstruction and simulated resection based on the CT findings of the patients, measure the residual liver volume and the liver volume in the first month after hepatectomy, calculate the regeneration rate of the residual liver volume in the first month after hepatectomy and discuss the significant factors that affect liver regeneration after hepatecto-my. Results: Of the 97 patients with hepatocellular carcinoma undergoing hepatectomy, 31 under-went left hemihepatectomy and 66 underwent right hemihepatectomy. The median liver regenera-tion rate in the first month after surgery was 17.6% in all patients. The median liver regeneration rate in the right hemihepatectomy group was 20.29%; The median liver regeneration rate in the left hemihepatectomy group was 12.2% after surgery. Univariate analysis showed age (P < 0.05), Gender (P < 0.05), history of alcohol consumption (P < 0.05), degree of cirrhosis (P < 0.05), and standard residual liver volume (P < 0.001) were significantly different between the high regenera-tion group and the low regeneration group (P < 0.05). Multivariate logistic regression analysis showed that degree of cirrhosis (OR = 0.294, 95%CI: 0.100~0.871, P = 0.027) and SRLV (OR = 0.989, 95%CI: 0.983~0.994, P < 0.001) were independent risk factors for liver regeneration after hepa-tectomy for hepatobiliary tumors.
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