| Objective:This study aims to explore the risk factors for achieving textbook outcomes after laparoscopic hepatectomy for hepatocellular carcinoma(HCC),with a view to providing reference and guidance for the clinical treatment of perioperative patients.Research methods:Retrospective data of 276 patients with HCC who had undergone laparoscopic hepatectomy in the Second Department of Hepatobiliary and Pancreatic Surgery at Jilin University’s one Hospital from March 2020 to March 2022 was collected.The short-term postoperative outcomes of patients were split into two groups:the TO group,which had textbook outcomes,and the non TO group,who had non textbook outcomes.Collating and analyzing the general data,preoperative examination data,and surgical pathology data of the two groups of patients was done with the aid of Excel 2010 and SPSS24.0 software.A logistic regression analysis of both single factor and multivariate nature was executed to ascertain the elements impacting TO.Research results:The study encompassed 276 patients,split into 190 in the TO group and non-TO group,with a TO rate of 68.8%.86 patients in the non-TO group:15 patients with R1 resection,5.4%;Severe complications occurred in 34 cases(12.3%);5 cases were re-admitted within 30 days,1.8%;One case died,0.4%,and 69 cases were hospitalized longer,25%.Of the 86 patients without TO,34 patients had serious complications within 30 days after operation,including 19 cases(55.9%)of massive ascites;9 cases(26.5%)had massive pleural effusion;There were 3 cases of bleeding(8.8%);1 case of liver failure(3%);Cases of intestinal obstruction were 5.8%.A statistical univariate analysis revealed a marked disparity between the TO and non-TO cohorts in 12 areas:long-term drinking history,gender,and Child-pugh grade.The tumor number,maximum diameter,resection range,intraoperative blood transfusion,operation time,blood loss,and location(P<0.05)were all evaluated using alanine aminotransferase and platelet.An analysis of binary logistic regression was conducted to analyze the aforesaid factors,and the independent risk factors for laparoscopic hepatectomy were revealed to be Child-pugh grade B(OR:0.478,95%CI:0.243-0.942,P=0.033<0.05),and operation time(OR:0).The ROC curve analysis revealed a 0.744 AUC value for the operation time,with a P-value of less than 0.01.Additionally,long-term drinking history had a positive correlation(OR:0.478,95%CI:0.239-0.958,P=0.037<0.05)with a coefficient of 0.983,95%CI:0.975-0.991,P≤0.01.The greatest predictive value for TO was found in the amalgamation of the three indicators,with an AUC value of 0.770 and a P-value of less than 0.01.Research conclusions:(1)Sex,long-term drinking history,Child-pugh grade,alanine aminotransferase,platelets,operation time,blood loss,intraoperative blood transfusion,resection range,tumor number,maximum diameter,tumor location are the predictive factors of TO in HCC patients after LH operation(2)Long-term drinking history,Child-pugh grade B,Prolonged surgical time are independent risk factors for HCC patients to reach TO after LH operation(3)The combination of long-term drinking history,Child-pugh grade B,and surgical time>115 minutes has a good predictive effect on postoperative non TO. |
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