围手术期抗病毒治疗对HBV相关性肝癌手术并发症的影响

摘要

Objective To investigate the effect of perioperative antiviral therapy on surgical complications of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods Totally 125 patients with HCC treated in the Department of Hepatobiliary Surgery in our hospital from January 2012 to October 2015 were selected for the study. According to the preoperative HBV-DNA load, the patients were divided into low load (LL) group and high load (HL) group. Some patients in the HL group were given antiviral therapy (AVT group), the other patients were not given (UN group). The postoperative liver function, HBV-DNA load, complications and pathological factors related to complications were compared. Results The indexes of liver function after treatment showed a general trend of initial elevation, then reduced. HBV-DNA load was decreased after treatment in the AVT group. The incidences of complications were lower and hospital stay was shorter in the LL group and the AVT group than in the UN group. Multivariate analysis showed that Child classification, tumor size and lack of antiviral therapy were independent risk factors for postoperative complications. Conclusions HCC patients with high HBV-DNA load have increased incidences of postoperative complications. Perioperative antiviral treatment can reduce postoperative complications and promote patient recovery.%目的 探讨肝细胞性肝癌(HCC)围手术期抗乙型肝炎病毒(HBV)治疗对术后并发症的影响.方法 选取2012年1月-2015年10月在辽宁省锦州市中心医院行外科根治术的125例HBV相关HCC患者.按术前HBV-DNA载量分为低载量组(LL)和高载量组(HL),高载量组中部分患者行抗HBV治疗(AVT),部分患者不行抗HBV治疗(UN).比较患者术后肝功能变化、病毒载量变化、并发症情况以及与并发症相关的病理因素.结果 术后患者肝功能指标先升后降,UN组各项指标下降曲线均高于LL组和AVT组.AVT组患者服药后HBV-DNA水平降低.LL组和AVT组患者并发症少于UN组,住院时间减少.多因素分析显示,Child分级、肿瘤大小以及是否抗病毒是HCC患者术后并发症的独立因素.结论 HCC术前高载量HBV-DNA患者术后并发症增加,围手术期抗病毒治疗可以减少术后并发症,促进患者恢复.