肝细胞癌患者行腹腔镜肝切除术后未实现教科书式结局的危险因素分析

Analysis of Risk Factors for Failure to Achieve a Textbook Outcome after Laparoscopic Hepatectomy in Patients with Hepatocellular Carcinoma

摘要: 目的：探讨肝细胞癌(HCC)患者行腹腔镜肝切除术(LH)后未实现教科书式结局(TO)的危险因素，为术前优化提供依据。方法：回顾性分析2020年1月至2023年12月于嘉兴大学附属医院行LH的140例HCC患者的临床资料。根据TO标准分为TO组(100例)与非TO组(40例)。采用单因素及多因素Logistic回归分析筛选未实现TO的独立危险因素。结果：总体TO率为71.4%。单因素分析显示，饮酒史、术前白蛋白水平、手术时间、失血量、肿瘤数量及肿瘤位置与非TO显著相关(P < 0.05)。多因素Logistic回归分析表明，饮酒史(OR = 4.194, 95% CI 1.636~10.756, P = 0.003)和较低术前白蛋白水平(OR = 0.898, 95% CI 0.825~0.976, P = 0.012)是未实现TO的独立危险因素。非TO组中30天内再入院10例，90天内死亡2例，住院时间延长32例，术后30天内并发症7例(腹腔积血积液4例、腹腔出血需再次手术1例、胆漏1例、大量胸腔积液1例)。结论：饮酒史和低术前白蛋白水平与LH术后TO未达成相关，TO达成率的提升主要受限于术后住院时间延长，针对可修正危险因素的识别和干预可能有助于改善TO达成率。

Abstract: Objective: To investigate the risk factors for failure to achieve a textbook outcome (TO) after laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC), and to provide evidence for preoperative optimization. Methods: Clinical data of 140 HCC patients who underwent LH at Affiliated Hospital of Jiaxing University from January 2020 to December 2023 were retrospectively analyzed. Patients were divided into a TO group (n = 100) and a non-TO group (n = 40) according to TO criteria. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for non-TO. Results: The overall TO rate was 71.4%. Univariate analysis showed that a history of alcohol consumption, preoperative albumin level, operative time, blood loss, number of tumors, and tumor location were significantly associated with non-TO (all P < 0.05). Multivariate logistic regression identified a history of alcohol consumption (OR = 4.194, 95% CI 1.636~10.756, P = 0.003) and a lower preoperative albumin level (OR = 0.898, 95% CI 0.825~0.976, P = 0.012) as independent risk factors for non-TO. In the non-TO group, 10 patients required readmission within 30 days, 2 died within 90 days, 32 had a prolonged hospital stay, and 7 developed postoperative complications within 30 days (including hemoperitoneum/peritoneal effusion in 4, intra-abdominal hemorrhage requiring reoperation in 1, bile leakage in 1, and massive pleural effusion in 1). Conclusions: Alcohol history and low preoperative albumin were associated with TO non-attainment after LH. The improvement of TO rates was predominantly driven by prolonged postoperative hospitalization, and identifying plus managing these modifiable risk factors might enhance TO attainment.