HBV肝硬化相关早期肝癌切除术后感染危险因素分析

曾三平 蒋星星

【摘要】 目的：探討乙型肝炎（HBV）肝硬化早期肝癌患者术后感染发生的危险因素。方法：选取2017年5月-2020年5月本院收治的88例HBV肝硬化早期肝癌患者，所有患者均行肝切除术，分析术后感染发生的可能危险因素，并进行单因素及logistic多因素回归分析，将术后感染发生的危险因素进行风险分层，分为高危、中危、低危，比较不同风险分层下感染发生率。结果：88例患者术后15例出现感染症状，发生率为17.0%。感染患者和非感染患者的年龄、糖尿病史、肝功能Child-Pugh分级、ALB、术中出血量、肝切除范围、腹腔引流管留置时间、有无输血、有无胆漏情况比较，差异均有统计学意义（P<0.05）。糖尿病史、ALB、术中出血量、腹腔引流管留置时间、胆漏是导致患者术后感染发生的独立危险因素（P<0.05）。术后不同感染发生风险分层患者感染发生情况比较，差异有统计学意义（P<0.05）。结论：年龄、糖尿病史、肝功能分级、ALB、出血量、肝切除范围、腹腔引流管留置时间、有无输血、有无胆漏与肝切除术后感染相关，建议临床上对感染高风险患者，尽早予以抗菌药物干预。

【关键词】 乙型肝炎肝硬化 早期肝癌 风险分层

Analysis of Risk Factors of Infection after Resection of HBV Cirrhosis Related Early Liver Cancer/ZENG Sanping， JIANG Xingxing. //Medical Innovation of China， 2021， 18（27）： -131

[Abstract] Objective： To investigate the risk factors of infection after resection of HBV cirrhosis related early liver cancer. Method： A total of 88 patients with early liver cancer due to HBV cirrhosis from May 2017 to May 2020 were selected， all patients underwent hepatectomy. The possible risk factors of postoperative infection were analyzed， and univariate and logistic regression analysis were performed. The risk factors of postoperative infection were stratified into high risk， medium risk and low risk. The incidence of infection under different risk stratification was compared. Result： A total of 15 cases of 88 patients with postoperative infection symptoms， the incidence rate was 17.0%. There were significant differences between infected and non-infected patients in age， history of diabetes， liver function Child-Pugh grade， ALB， intraoperative blood loss， scope of liver resection， duration of abdominal drainage， blood transfusion and biliary leakage （P<0.05）. Diabetes， ALB， intraoperative blood loss， duration of abdominal drainage and biliary leakage were independent risk factors for postoperative infection （P<0.05）. There were significant differences in the incidence of infection among patients with different risk stratification （P<0.05）. Conclusion： Age， history of diabetes， liver function grade， ALB， intraoperative blood loss， scope of liver resection， duration of abdominal drainage， blood transfusion and postoperative biliary leakage are significantly related to postoperative infection after hepatectomy. It is suggested that patients with high risk of infection should be intervened with antibiotics as soon as possible.

[Key words] HBV cirrhosis Early liver cancer Risk stratification

First-author’s address： Xinyu People’s Hospital， Xinyu 338000， China

doi：10.3969/j.issn.1674-4985.2021.27.032

近年来，我国原发性肝癌（PLC）的患病率不断增加，已成为常见的一类恶性肿瘤，其发病与多种因素密切相关，如遗传、物理、病毒感染等，其中乙型病毒性肝炎（HBV）肝硬化是导致PLC发生的首要危险因素[1-2]。对于该部分患者，目前临床诊治指南推荐在常规抗病毒治疗基础上定期随访，以便早期发现PLC并行肝切除术，延长患者生存时间[3-4]。……