肝门部胆管癌术后胆红素的动态变化规律及影响因素分析

摘要

目的 分析肝门部胆管癌(HCCA)术后胆红素的动态变化规律及影响因素.方法 回顾性分析2011年2月至2016年2月我院275例HCCA患者的临床资料,均行HCCA根治术,根据术后血清总胆红素(TBIL)变化趋势分为观察组(胆红素逐渐下降,n=165)、对照组(胆红素一过性升高,n=110),分析两组术后2周内血清TBIL变化情况,比较其术前白蛋白(Alb)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、TBIL、甲胎蛋白(AFP)、糖类抗原199(CA199),分析术后1～6d平均TBIL与上述指标的相关性,对比两组手术资料、预后情况,分析引起术后胆红素升高的独立危险因素.结果 观察组术后2周内胆红素逐渐下降,在术后第13～14d复常,对照组术后第1～6d胆红素升高,第4～6d达高峰后下降,复常时间＞14d;观察组术前ALP(405.12±1.88) U/L、GGT(654.23±1.35) U/L与对照组比较明显较高(P＜0.05),观察组CA199水平(110.23 ±1.47)kU/L低于对照组(P＜0.05);相关分析显示术后1～6 d平均TBIL与患者ALP、GGT水平呈负相关(P＜0.05),与CA199呈正相关(P＜0.05);观察组术前减黄比例23.64％、输血率38.79％、肝切除率56.36％、肝硬化比例4.85％明显低于对照组70.91％、62.73％、78.18％、14.55％ (P ＜0.05),观察组住院时间(25.04±1.23)d短于对照组,观察组术后1个月内并发症发生率9.05％低于对照组20.91％ (P ＜0.05),两组生存时间比较无显著差异(P＞0.05);Logistic回归分析显示ALP、GGT、CA199水平及术前减黄、输血、肝切除是导致胆红素一过性升高的独立危险因素(P＜0.05).结论 ALP、GGT、CA199水平及术前减黄、输血、肝切除是引起肝门部胆管癌术后胆红素一过性升高的独立危险因素,并增加并发症发生率,延长住院时间,临床需加以监测.%Objective To analyze the dynamic changes of bilirubin and the influencing factors in patients with hilar cholangiocarcinoma (HCCA) after operation.Methods The clinical data of 275 HCCA patients admitted to our hospital during February 2011 ～ February 2016 were retrospectively analyzed.All patients were treated with HCCA radical operation.According to the changes of serum total bilirubin (TBIL) after operation,the patients were divided into the observation group (bilirubin decreased gradually,n =165) and the control group (bilirubin increased transiently,n =110).Changes of serum TBIL in the two groups within 2 weeks after operation were analyzed.The albumin (Alb),alkaline phosphatase (ALP),gamma glutamyl transpeptidase (GGT),TBIL,alpha fetoprotein (AFP) and carbohydrate antigen 199 (CA199) were compared between the two groups.The correlation between the average TBIL in 1 ～ 6 d after operation and the above indexes was analyzed.The operation data and prognosis were compared between the two groups,the independent risk factors of increased bilirubin were analyzed.Results In the observation group,bilirubin decreased gradually within 2 weeks after operation and recovered on the 13th ～ 14th day after operation while in the control group,it increased on the 1st ～ 6th day after operation and reached the peak and then decreased on the 4th ～ 6th day after operation.The recovery time was 14 days.Before operation,levels of ALP and GGT were significantly higher,CA199 level was lower in observation group than thc control group (P ＜ 0.05).Correlation analysis showed that the average TBIL was negatively correlated with ALP and GGT levels and positively correlated with CA199 level (P ＜ 0.05).The proportion of preoperative biliary drainage,blood transfusion rate,liver resection rate and the proportion of liver cirrhosis were significantly lower in observation group than the control group (23.64％,38.79％,56.36％,4.85％ vs 70.91％,62.73％,78.18％,14.55％) (P ＜0.05).The hospitalization time of observation group was shorter than the control group.The incidence of complications within 1 month after operation was lower in observation group than the control group (9.05％ vs 20.91％) (P ＜ 0.05).There was no significant difference between the two groups in survival time (P ＞ 0.05).Logistic regression analysis showed that levels of ALP,GGT,and CA199,preoperative biliary drainage,blood transfusion and liver resection were independent risk factors for transient increase of bilirubin (P ＜ 0.05).Conclusion Levels of ALP,GGT and CA199,preoperative jaundice,blood transfusion and liver resection are the independent risk factors for transient increase of bilirubin after operation of HCCA.The above indexes may increase the incidence of complications and prolonged hospitalization time.Therefore,they should be monitored.