Cigarette smoking increases risk of early morbidity after hepatic resection in patients with hepatocellular carcinoma
Cigarette smoking increases risk of early morbidity after hepatic resection in patients with hepatocellular carcinoma
复制标题
吸烟会增加肝细胞癌患者肝切除术后早期发病的风险
DOI：
10.1016/j.ejso.2015.01.015
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发表时间：
2015-04-01
期刊：
影响因子：
3.8
通讯作者：
Zhang, X. -F.
中科院分区：
文献类型：
--
作者：
Lv, Y.;Liu, C.;Zhang, X. -F.
目的：吸烟是重大外科手术后肺部并发症发生的重要危险因素。本研究的目的是探讨术前吸烟是否对肝细胞癌（HCC）术后早期发病率有影响。方法：回顾性分析425例连续行肝部分切除术的HCC患者的资料。记录吸烟和饮酒习惯、生化检查、肿瘤状况、手术资料以及出院前发生的任何术后并发症。采用单因素和多因素分析导致术后并发症的危险因素。结果：总发病率为40%（170 / 425）。166例患者目前为吸烟者（39%）。多因素分析显示，肝硬化（危险比（RR） 4.0, 95%可信区间（CI） 2.0 ~ 8.0）、吸烟状况（RR 3.0, 95% CI 1.7 ~ 5.1）、吸烟程度（RR 1.3, 95% CI 1.1 ~ 1.9）、术前血小板计数（RR 1.6, 95% CI 1.4 ~ 2.0）和主要肝切除术（RR 1.4, 95% CI 1.1 ~ 1.8）是术后发病率的独立危险因素（均p < 0.05）。吸烟者比非吸烟者更容易发生肝功能衰竭、胆漏、顽固性腹水、胸部和伤口感染。在肝脏正常和肝硬化患者中，吸烟者术后发病率高于不吸烟者和曾经吸烟者（p = 0.047和p < 0.001）。结论：吸烟是肝癌部分肝切除术患者发生肝脏相关并发症和感染性并发症的独立危险因素，尤其是肝硬化患者。(C) 2015 Elsevier Ltd.版权所有。
Aims: Cigarette smoking is an important risk factor for the development of postoperative pulmonary complications after major surgical procedures. The objective of this study was to investigate whether preoperative smoking has any impact on early morbidity after liver resection for hepatocellular carcinoma (HCC).Methods: Data of 425 consecutive patients undergoing partial hepatectomy for HCC was retrospectively reviewed. Smoking and drinking habits, biochemical tests, tumor status, operation data, and any postoperative complications occurring before discharge from the hospital were documented. The risk factors promoting postoperative complications were analyzed by univariate and multivariate methods.Results: The overall morbidity rate was 40% (170 of 425). 166 patients were current smokers (39%). By multivariate analysis, liver cirrhosis (Risk Ratio (RR) 4.0, 95% confidence interval (CI) 2.0-8.0), smoking status (RR 3.0, 95% CI 1.7-5.1), PY of smoking (RR 1.3, 95% CI 1.1-1.9), preoperative platelet count (RR 1.6, 95% CI 1.4-2.0) and major hepatectomy (RR 1.4, 95% CI 1.1-1.8) were independent risk factors of postoperative morbidity (all p < 0.05). Liver failure, bile leakage, intractable ascites, chest and wound infection were more frequently occurred in smokers than non-smokers. Current smokers had higher postoperative morbidity than non-& former smokers in patients with normal liver and those with liver cirrhosis (p = 0.047 and p < 0.001, respectively).Conclusions: Cigarette smoking is an independent risk factor for the development of liver-related and infectious complications in patients undergoing partial hepatectomy for HCC, especially in those with liver cirrhosis. (C) 2015 Elsevier Ltd. All rights reserved.