Effect Of Preoperative Antiviral Therapy On Liver Function Recovery And Complications After Operation Of Hepatocellular Carcinoma

Objective:To study whether the high load of hepatitis B virus(HBV)DNA in patients with hepatitis B-related hepatocellular carcinoma(HCC)will affect the postoperative liver function recovery and complications.Methods:This study was a retrospective analysis of 52 patients with HCC who met the inclusion criteria and received the hepatobiliary surgery in the First Affiliated hospital of Kunming Medical University from December 2012 to December 2016.Patients were preoperatively administrated with entecavir 0.5 mg qd po or adefovir dipivoxil 10 mg qd po or lamivudine 0.1 g qd po or the latter two combined treatment for 1-3 weeks,of which 31 patients whose HBV-DNA dropped to 103 copies/ml or below were defined as antiviral group(HBV-DNA<103 copies/ml,n=31)and 21 patients who were not treated with antiviral therapy and had HBV-DNA>103 copies/ml were defined as non-antiviral group(HBV-DNA>103 copies/ml,n = 21).The age,sex,liver cirrhosis,AFP,Child-Pugh classification,positive or negative attributes of HBeAg,surgical methods,resection of liver segment,operation time,hepatic portal obstruction,intraoperative bleeding,intraoperative and postoperative blood transfusion,postoperative pathological grading,liver function before and 1,3,7 days after operation,HBV-DNA value before and 7 days after operation and postoperative complications were statistically analyzed.Using the statistical t test,paired t test,repeated data analysis of variance and x2 test were used to analyze the results of these two groups of patients comparatively.Results 52 patients with HCC received effective hepatectomy.According to t test,there was no significant difference in the HBV-DNA value before and 7 days after operation in non-antiviral group(P=0.437),and so as the antiviral group(P ?0.918).There was no no significant difference in age,sex,liver cirrhosis,AFP,Child-Pugh classification,positive or negative attributes of HBeAg,surgical methods,resection of liver segment,operation time,hepatic portal obstruction,intraoperative bleeding,intraoperative and postoperative blood transfusion and postoperative pathological grading between the two groups before operation(P>0.05).And rhere was no significant difference in ALT.AST.PT and TBIL between the two groups before operation(P=0.550%,0.747%,0.920%,0.676%,respectively).The recovery of liver function in antiviral group was better than that in non-antiviral group.In the comparative analysis of single complications after operation,the antiviral group(HBV-DNA ? 103 copies/ml,n=31)and non-antiviral group(HBV-DNA>103 copies/ml,n = 21)had significant difference in refractory ascites(defined as that after a certain time of strict water,sodium control and full diuretic treatment,there was still no obvious effect and the perioperative ascites was>500 ml/days)and incision delayed union(here defined as due to ascites,biliary fistula and infection the incision does not heal and stitches time was>12 days)(P=0.034,0.023,respectively).In the postoperative o'verall complications,the difference between the two groups of patients was also statistically significant(P = 0.012).Conclusions:In this study,HBV-DNA changes of HCC patients from non-antiviral group before operation and during postoperative perioperative period and HBV-DNA changes of HCC patients from antiviral group before operation and during postoperative perioperative period were analyzed.Because the number of cases is small,the differences had no statistical significance,and the preoperative antiviral therapy(HBV-DNA drops to 103 copies/ml or below)is more helpful for the postoperative liver function recovery and reduction of postoperative complications in HCC patients.