目的 研究生理能力和手术应激评分(estimation of physiologic ability and surgical stress,E-PASS)与原发性肝癌患者根治性肝切除术围术期并发症的关系.方法 回顾性选择山东省立医院2022年3月—2023年5月收住入院的原发性肝癌患者124例作为研究对象,均在本院接受根治性肝切除术.统计围术期并发症情况,按是否发生并发症分为发生组(n=29)和未发生组(n=95),对比两组患者临床资料和疾病相关特征,并进行E-PASS评价,采取多因素logistic回归方程分析根治性肝切除术围术期并发症和各指标的关系,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,预测E-PASS评价原发性肝癌患者根治性肝切除术围术期并发症的价值.结果 124例接受根治性肝切除术的患者中,围术期出现并发症的患者有29例(23.39%),其中肝功能衰竭2例(1.61%)、胸腔积液6例(4.84%)、腹腔脓肿4例(3.23%)、术后出血8例(6.45%)、腹腔感染9例(7.26%);另外,未发生并发症的患者有95例(76.61%).发生组和未发生组在年龄、术中出血量、术前总胆红素、术前白蛋白方面相比,差异均有统计学意义(P<0.05).发生组术前风险分值(preoperative risk score,PRS)、手术应激分值(surgical stress score,SSS)、综合风险分值(composite risk score,CRS)评分均高于未发生组,差异均有统计学意义(P<0.05).经多因素logistic回归方程分析,发现PRS、SSS、CRS均会对原发性肝癌患者根治性肝切除术围术期并发症产生显著的正向影响关系(P<0.05).通过绘制ROC曲线,发现E-PASS预测根治性肝切除术围术期并发症存在一定价值,其曲线下面积(area under the curve,AUC)分别是0.617、0.614、0.601.结论 原发性肝癌患者经根治性肝切除术后,围术期并发症发生率较高,需引起重视,且通过E-PASS预测其围术期并发症的价值较高,值得临床推广使用.
Relationship between physiologic capacity and surgical stress score on perioperative complications of radical hepatectomy in patients with primary hepatocellular carcinoma
Objective:To study the relationship between physiologic ability and surgical stress score(E-PASS)and perioperative complications of radical hepatectomy in patients with primary liver cancer.Methods:124 primary hepatocellular carcinoma patients admitted to our hospital from March 2022 to May 2023 were retrospectively selected as the study subjects,all of whom underwent radical hepatectomy in our hospital.The perioperative complications of these patients were statistically analyzed,and then they were divided into two groups based on the presence or absence of complications,namely the occurrence group(n=29)and the non-occurrence group(n=95).The clinical data and disease-related characteristics of the two groups of patients were compared and E-PASS evaluation was conducted.The multifactorial Logistic regression equation was taken to analyze the relationship between perioperative complications of radical hepatectomy and various indictors,and then ROC curve graphs were drawn to predict the value of E-PASS in evaluating perioperative complications of radical hepatectomy in patients with primary liver cancer.Results:A total of 124 patients were included in this paper who underwent radical hepatectomy,and 29 patients(23.39%)had perioperative complications,including 2 cases of liver failure(1.61%),6 cases of pleural effusion(4.84%),4 cases of abdominal abscess(3.23%),8 cases of postoperative hemorrhage(6.45%),and 9 cases of abdominal cavity infection(7.26%).In addition,patients with no complications were 95 cases(76.61%).The difference between the occurrence group and the non-occurrence group was significant in terms of age,intraoperative bleeding,preoperative total bilirubin,and preoperative albumin(P<0.05).The preoperative risk score(PRS),surgical stress score(SSS),and composite risk score(CRS)scores were all higher in the occurrence group than those in the non-occurrence group(P<0.05).After multifactorial logistic regression analysis,it was found that PRS,SSS,and CRS would all have a significant positive influence relationship on perioperative complications of radical hepatectomy in patients with primary hepatocellular carcinoma(P<0.05).Meanwhile,by drawing ROC curves,it was found that E-PASS has certain value in predicting perioperative complications of radical liver resection with AUCs of 0.617,0.614,and 0.601 respectively.Conclusion:The perioperative complications of primary hepatocellular carcinoma patients after radical hepatectomy are high,which need to be paid attention to.And the value of predicting perioperative complications by E-PASS is higher,which is worth being popularized in clinic use.
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