全腹腔镜和传统开腹肝癌切除术对乙型肝炎病毒再激活的影响

摘要

Objective To study the effect of total laparoscopic and traditional open hepatectomy on hepatitis B virus (HBV) reactivation.Methods The data of 158 patients undergoing hepatectomy were reviewed, including 102 cases undergoing total laparoscopic surgery and 56 cases undergoing open surgery.The risk factors of HBV reactivation were analyzed according to the status of postoperative HBV reactivation.Results Twenty patients had postoperative HBV reactivation.Logistic univariate and multivariate analysis showed that surgical approach [OR(95%CI) 3.217(1.325,8.624),P=0.012] and antiviral therapy [OR(95%CI)0.351(0.115,0.749),P=0.025] were the independent risk factors for postoperative HBV reactivation;The HBV reactivation rates in the total laparoscopic group and open group were 8.5% and 27.3%, respectively, the difference is statistically significant (P<0.05).The tumor size, duration of surgery, intraoperative blood loss, cases with intraoperative blood transfusion in the total laparoscopic group were significantly small, shorter, less and fewer than those in open group, the difference is statistically significant (P<0.05);Among patients having HBV reactivation, there were 11 cases treated by antiviral therapy.The HBsAg positive rate and cases with high HBV-DNA copy in cases receiving antiviral therapy were significantly higher and more than those in patients not receiving antiviral therapy, the difference is statistically significant (P<0.01).Conclusion The surgical methods and antiviral therapy are the independent risk factors of HBV reactivation.Long duration of traditional open resection of hepatocellular carcinoma, increase of intraoperative blood loss and blood transfusion can increase the risk of HBV reactivation.Preoperative antiviral therapy for patients with negative or low copy number of HBV can reduce the risk of HBV reactivation.%目的 研究全腹腔镜和传统开腹肝癌切除术对乙型肝炎病毒(HBV)再激活的影响.方法 对158例行肝癌切除手术治疗的患者资料进行回顾分析,其中行全腹腔镜手术者102例,开腹手术者56例,依据术后HBV再激活情况,分析影响HBV再激活危险因素.结果 20例患者发生术后HBV再激活,Logistic单因素和多因素分析显示,手术方式[OR值(95%CI) 为3.217(1.325,8.624),P=0.012]和抗病毒治疗[OR值(95%CI)0.351(0.115,0.749),P=0.025]是影响术后HBV再激活的独立危险因素;全腹腔镜组、开腹组HBV再激活率分别为8.5%和27.3%,差异有统计学意义(P<0.05);全腹腔镜组肿瘤大小、手术时间、术中失血量、术中输血例数均显著小于或短于传统开腹组,差异具有统计学意义(P<0.05);HBV再激活患者中抗病毒治疗者11例,抗病毒治疗的HBV表面抗原阳性率和高HBV-DNA拷贝量例数显著高于未抗病毒治疗,差异具有统计学意义(P<0.01).结论 手术方式和抗病毒治疗是影响术后HBV再激活的独立危险因素,传统开腹肝癌切除术过程手术时间的延长、术中失血量的增多和输血均会增加HBV再激活风险,选择腹腔镜手术和术前抗病毒治疗可降低HBV术后再激活风险.