Analysis Of Related Factors Of Pleural Effusion After Hepatectomy Of PLC

Background and objective:Primary hepatocellular carcinoma(PLC)is a malignant tumor that occurs in hepatocytes or intrahepatic bile duct epithelial cells,mainly including hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC).It is the fifth most common malignant tumor in the world and the second leading cause of cancer death.About 250000 people die of primary liver cancer in the world every year,and China accounts for about 45%,which is one of the main causes of tumor death in China.At present,surgical treatment is the most important means for patients with primary liver cancer to achieve long-term survival,including hepatectomy,radiofrequency ablation and liver transplantation,in which hepatectomy is still the most important means for the treatment of primary liver cancer.Hepatectomy in the treatment of primary liver cancer,but also caused some related complications,such as bleeding,infection,bile leakage,ascites,pleural effusion and so on,especially pleural effusion has attracted more and more attention.Hideaki et al reported that the incidence of pleural effusion after hepatectomy for liver cancer was 54.5%.The exact cause of pleural effusion after hepatectomy is still unknown.At present,it is believed that many factors lead to the occurrence of pleural effusion after hepatectomy.In this study,154 patients with primary liver cancer treated in our department were retrospectively analyzed,and the general data,preoperative examination and examination data,intraoperative and postoperative data were analyzed to explore the influencing factors of pleural effusion after resectionof liver cancer.To provide some possible help and ideas for hepatobiliary surgeons to prevent pleural effusion after resection of liver cancer.Methods:To collect the factors that may affect the occurrence of pleural effusion after hepatectomy:(1)General data of patients,such as sex,age,BMI,history of smoking,history of drinking,history of diabetes,history of hypertension,history of coronary heart disease,history of hepatitis B,history of hepatitis C;(2)Preoperative examination and examination data of patients,such as liver cirrhosis,ascites,portal hypertension,color ultrasound grading of liver fibrosis,fatty liver,lung CT findings,liver CT or MRI indicating tumor location,Child-Pugh grade,preoperative indocyanine green clearance test(ICG),preoperative albumin(ALB),preoperative prothrombin time(PT),preoperative glutamic pyruvic transaminase(ALT),preoperative aspartate aminotransferase(AST),preoperative hemoglobin(HB),preoperative creatinine(CR),preoperative platelet(BLT);(3)Intraoperative data,such as the mode of operation(Open surgery and Laparoscopic surgery),combined cholecystectomy,combined radiofrequency ablation,occlusion of the first hepatic hilum,resection site,blood loss,operation time,intraoperative fluid volume,intraoperative blood transfusion volume;(4)Postoperative data,such as pathological type,number of tumors,degree of differentiation,TNM stage,subphrenic effusion,bile leakage,early postoperative oral diuretics,ALB on the 1st day after operation,average ALB on the 5th day after operation,tumor volume,total bilirubin(TB)on the 5th day after operation,fluid volume in 24 hours after operation.1.The general data,preoperative examination and examination data,intraoperative data,postoperative data and whether complicated with pleural effusion were assigned to SPSS 25.0 for univariate analysis,and the influencing factors of pleural effusion after resection of primary liver cancer were obtained.2.In order to eliminate the role of confounding factors and further clarify the influence of single factors on pleural effusion after resection of primary liver cancer,the influencing factors related to pleural effusion after resection of primary liver cancer were included in binary Logistic regression analysis,and the independent influencing factors of pleural effusion after resection of primary liver cancer were obtained.Results:1.Among the 149 patients who underwent resection of primary liver cancer,62 patients were complicated with pleural effusion,and the incidence of postoperative pleural effusion was 41.6%.2.Through univariate analysis: sex(P > 0.05),age(P > 0.05),BMI(P >0.05),number of cigarettes(packets)(P > 0.05),history of drinking(P > 0.05),history of diabetes(P > 0.05),history of hypertension(P > 0.05),history of coronary heart disease(P > 0.05),history of hepatitis B(P > 0.05),history of hepatitis C(P > 0.05),liver cirrhosis,ascites(P > 0.05),portal hypertension(P > 0.05),color ultrasound grading of liver fibrosis(P > 0.05),fatty liver(P > 0.05),preoperative lung CT(P > 0.05),Child-Pugh grade(P >0.05),preoperative ICG(P > 0.05),Preoperative PT(P > 0.05),preoperative creatinine(P > 0.05),preoperative AST(P > 0.05),preoperative ALT(P > 0.05),preoperative TB(P > 0.05),preoperative HB(P > 0.05),preoperative PLT(P >0.05),combined cholecystectomy(P > 0.05),combined radiofrequency ablation(P > 0.05),operation time(P > 0.05),first porta hepatis or regional occlusion time(P > 0.05),intraoperative blood transfusion(P > 0.05),intraoperative fluid volume(P > 0.05),pathological type(P > 0.05),tumor number(P > 0.05),degree of differentiation(P > 0.05),TNM stage(P > 0.05),biliary leakage(P > 0.05),mean ALB at 5 days after operation(P > 0.05),tumor volume(P > 0.05),TBIL on the 5th day after operation(P > 0.05)are not associated with pleural effusion after resection of primary liver cancer.3.Through univariate analysis: liver CT or MRI indicated tumor location(P < 0.05),preoperative ALB(P < 0.05),mode of operation(P < 0.05),first hepatic hilar occlusion(P < 0.05),intraoperative resection site(P < 0.05),intraoperative blood loss(P < 0.05),subdiaphragmatic effusion(P < 0.05),oral diuretics early after operation(P < 0.05),ALB on the first day after operation(P < 0.05),total postoperative abdominal drainage(P < 0.05),average extraction time of abdominal drainage tube(P < 0.05),total postoperative blood transfusion(P < 0.05),The fluid volume 24 hours after operation(P <0.05)are the related factors of pleural effusion after resection of primary liver cancer.4.Multivariate analysis showed that the independent influencing factors of pleural effusion after resection of primary liver cancer were the mode of operation(P < 0.05),oral diuretics(P < 0.05)and the amount of fluid 24 hours after operation(P < 0.05).Conclusion:1.Liver CT or MRI indicates tumor location,preoperative ALB,operation mode,first hepatic hilar occlusion,intraoperative resection site,intraoperative blood loss,subdiaphragmatic effusion,oral diuretics early after operation,ALB on the first day after operation,total postoperative abdominal drainage,average extraction time of abdominal drainage tube,total postoperative blood transfusion,The fluid volume 24 hours after operation is the related factor of pleural effusion after resection of primary liver cancer.2.The operation mode of laparotomy is an independent risk factor for pleural effusion after resection of primary liver cancer,and oral diuretics is an effective independent protective factor for pleural effusion after resection of primary liver cancer.24 hours after operation,the amount of fluid was positively correlated with the possibility of pleural effusion after operation.