目的：探讨乙肝相关性肝癌（HCC）患者术前乙型肝炎病毒（HBV）DNA 载量与围手术期并发症发生的关系。方法：收集2010 年1 月—2014 年12 月行根治性手术治疗的HCC 患者共374 例资料，按照术前HBVDNA 载量分为低载量组（<1.0 E+04 IU/mL）和高载量组（≥ 1.0E+04 IU/mL）。比较两组患者术后肝功能变化情况、并发症及住院时间，并分析并发症与临床病理因素的关系。结果：两组患者各项血清肝功能指标术后均呈先升后降的趋势，但高载量组各项指标上升的幅度及峰值均大于低载量组（部分P<0.05）。与低载量组比较，高载量组术后肺部感染（18.9% vs. 5.2%）、胆汁漏（15.4% vs. 2.3%）、总并发症发生率（19.9% vs. 10.6%）增高、术后住院时间（13.70 d vs. 10.09 d）延长低（均P<0.05）。多因素分析提示，术前HBV DNA 载量（OR=0.865）、肝功能Child-Pugh 分级（OR=0.731）及肿瘤大小（OR=0.535）是引起手术并发症的独立危险因素（均P<0.05）。结论： 术前高HBV DNA 载量的HCC 患者围术期并发症增加及术后住院时间明显延长，术前HBVDNA 载量是引起手术并发症的独立危险因素。
Relationship between preoperative hepatitis B virus DNA level and perioperative complications in patients with hepatitis B-related hepatocellular carcinoma
Objective: To investigate the relationship between preoperative hepatitis B virus (HBV) DNA load and perioperative complications in patients with hepatitis B-related hepatocellular carcinoma (HCC). Methods: The clinical data of 374 HCC patients undergoing radical hepatectomy between January 2010 and December 2014 were collected. According to the preoperative HBV-DNA load, patients were divided into lowload group (HBV-DNA load<1.0 E+04 IU/mL) and high-load group (HBV-DNA load≥1.0E+04 IU/mL). The changes in postoperative liver function, occurrence of complications and length of hospitalization between the two groups were compared, and the relations of occurrence of complications with clinicopathologic factors were also analyzed. Results: The serum liver function indexes in both groups showed a general trend of initial increase and then decrease, but the increasing amplitudes and peak values of each index in high-load group were greater than those in low-load group (partial P<0.05).The incidence of postoperative pulmonary infection (18.9% vs. 5.2%) and bile leakage (15.4% vs. 2.3%), as well as overall incidence of postoperative complications (19.9% vs. 10.6%) were increased and hospital stay (13.70 d vs. 10.09 d) was prolonged in high-load group compared with low-load group (all P<0.05). Multivariate analysis identified that the preoperative HBV-DNA load (OR=0.865), Child- Pugh classification (OR=0.731) of liver function and tumor size (OR=0.535) were independent risk factors for occurrence of complications (all P<0.05). Conclusion: HCC patients with high preoperative HBV-DNA load may have an increased incidence of perioperative complications and prolonged postoperative hospital stay, and preoperative HBV-DNA is an independent risk factor for surgical complications.