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目的探讨原发性肝癌切除术后胆红素变化的规律及导致高胆红素血症的临床因素。方法回顾性分析97例原发性肝癌切除术患者临床资料,根据术后血清总胆红素水平分为高胆红素组和胆红素正常组,观察术后胆红素变化特点,分析导致术后高胆红素血症的临床因素。结果红素正常组术后血清总胆红素4 d达峰值[(21.5±9.2)μmol/L],术后14 d可降至正常水平;高胆红素血症组血清总胆红素7 d达峰值[(49.2±25.4)μmol/L],术后14 d仍高于正常值2倍[(36.1±17.6)μmol/L]。单因素Logistic分析显示:术前胆红素水平,肝功能Child分级,术中肝血流阻断方式,出血量,输血情况以及术后合并低钠血症与术后高胆红素血症有关;多因素Logistic回归分析结果表明术前胆红素水平是原发性肝癌切除术后高胆红素血症独立预测指标(OR=5.406,χ2=11.319,P=0.001)。结论原发性肝癌切除术后动态监测血清胆红素水平是重要的。围手术期对发生高胆红素血症的相关临床因素积极防范并处理,可降低肝癌切除术后并发症发生率。
Objective To investigate the changes of bilirubin after primary hepatectomy and the clinical factors leading to hyperbilirubinemia. Methods A retrospective analysis of 97 patients with primary liver cancer resection clinical data, according to postoperative serum total bilirubin levels were divided into high-bilirubin group and bilirubin normal group, observed bilirubin changes, the analysis led to Clinical factors of postoperative hyperbilirubinemia. Results Serum total bilirubin peaked at 4 d postoperatively in normal control group [(21.5 ± 9.2) μmol / L], and decreased to normal level 14 d after operation. Serum total bilirubin 7 d [(49.2 ± 25.4) μmol / L], which was still higher than normal at 14 d ([36.1 ± 17.6] μmol / L]. Univariate Logistic analysis showed that preoperative bilirubin level, Child classification of liver function, intraoperative occlusion of hepatic blood flow, amount of bleeding, blood transfusion, postoperative hyponatremia and postoperative hyperbilirubinemia Multivariate Logistic regression analysis showed that preoperative bilirubin level was an independent predictor of hyperbilirubinemia after resection of primary liver cancer (OR = 5.406, χ2 = 11.319, P = 0.001). Conclusion The dynamic monitoring of serum bilirubin level after primary hepatectomy is important. Perioperative period of the occurrence of hyperbilirubinemia-related clinical factors to actively prevent and deal with, can reduce the incidence of postoperative liver cancer resection.