Analysis Of The Relationship Between Serum Prealbumin Level And Hepatic Insufficiency After Hepatectomy

Objective:To investigate the relationship between serum prealbumin level and hepatic insufficiency after hepatectomyMethods:According to the inclusion and exclusion criteria,168 patients with primary liver cancer who underwent hepatectomy in Affiliated Hospital of Yan bian University from January 2012 to January 2019 were selected.The operation and postoperative management were completed by the same team.All clinical data of the patients were collected,including preoperative blood test results,imaging results,and course of disease records.According to the postoperative outcome of the patients,168 patients were divided into non-postoperative liver insufficiency group and postoperative liver insufficiency group.The gender,age,hepatitis background,preoperative complications,pathological results and other factors of the patients were analyzed statistically,and the risk factors of liver insufficiency after hepatectomy were analyzed,and the relationship between serum prealbumin and liver insufficiency after hepatectomy was further analyzed.Results:A total of 168 patients met the standard.General clinical data of the patients were statistically analyzed,including 130 males(77.38%)and 38 females(22.62%),with an average age of(55.8±7.8)years.There were 156(92.86%)cases of hepatocellular carcinoma,11(6.55%)cases of cholangiocellular carcinoma,and 1(0.60%)cases of mixed type.83.3%(140/168)of the patients had hepatitis background,and 147(87.5%)and 21(16.2%)of the patients had liver segmentectomy ≤3 and>4,respectively.Ninety patients(53.6%)had concurrent cirrhosis,and seven patients(4.2%)had controlled ascites before surgery.No hepatic insufficiency,according to the postoperative outcome situation into groups and postoperative liver function is not complete,including a total of 27(16.7%)patients in dysfunction occurred after liver resection,19 cases of biliary obstruction,bile leakage caused by high blood bilirubin,6 patients were characterized by ascites and blood coagulation of prolonged,1 case because of the postoperative patients with kidney failure cause multiple organ dysfunction in 7 days after death.The other patient died of hepatic encephalopathy 23 days after surgery.Using single factor test to two groups of various clinical factors were analyzed,and found that the two groups in the AFP,ALT,blood loss,blood transfusion amount,sex,tumor type and surgical removal of the range of difference there is no statistical significance(P>0.05),but in TB,propagated,PA,PT,preoperative complications,type of hepatitis and blocking time differences are statistically significant(P<0.05).Then using the single factor cox regression analysis found that ascites(P=0.035),total bilirubin(P=0.004),albumin(P=0.006),serum prealbumin(P<0.001),PT(P=0.003),the ALT(P=0.008)associated with postoperative hepatic insufficiency,will be the meaningful single factor to multi-factors cox regression analysis further confirmed that the serum prealbumin was a risk factor for hepatic insufficiency occurred after liver resection(P<0.001).The optimal threshold value of serum prealbumin was 158.5mg/L,ACU=0.874,specificity was 77.8%and sensitivity was 87.2%by ROC curve.Conclusion:Serum prealbumin(PA)is an independent risk factor for liver dysfunction in hepatectomy for hepatocellular carcinoma.In clinical practice,the level of prealbumin can provide a basis for preoperative evaluation of patients with primary liver cancer,so as to avoid or reduce the occurrence of postoperative liver dysfunction.