目的：探讨肝功能Child-Pugh A 级患者行肝切除术后肝功能不全的危险因素。方法：选择2010 年10 月—2014 年4 月间427 例连续的术前肝功能Child-Pugh A 级行肝切除术的原发性肝癌患者。手术均由同一团队实施，均在肝门阻断下进行（肝门阻断15 min/ 间断5 min）。收集患者的临床资料，分析肝切除术后肝功能不全的危险因素。结果：427 例患者中，男362 例，女65 例，平均年龄（51.1±10.4）岁；肝细胞癌391 例，胆管细胞癌31 例，两者混合型5 例；86.4%（369/427）患者有肝炎背景，54.8%（234/427）患者同时伴有肝硬化；≤ 3 个肝段切除与≥ 4 个肝段切除的患者分别为358 例（83.8%）及69（16.2%）例。17 例（4.0%）发生肝切除术后发生功能不全，其中10 例表现为非胆道阻塞、胆汁漏引起的高胆红素血症，6 例患者表现为明显的腹水及凝血时间延长，1 例患者因肝性脑病于术后21 d 死亡。单因素分析发现年龄≥ 60 岁、血清前白蛋白<170 g/L 与术后肝功能不全有关（P=0.045，P=0.009），多因素分析证实血清前白蛋白<170 g/L 是肝切除术后肝功能不全危险因素（HR=3.192，95% CI=1.185~8.601，P=0.022）。结论：血清前白蛋白水平是Child-Pugh A 级患者行肝切除术后肝功能不全的独立影响因素，术前改善患者的营养状况可降低术后肝功能不全的发生率。
Influence of serum prealbumin level on occurrence of posthepatectomy hepatic insufficiency
Objective: To determine the risk factors for posthepatectomy liver failure in patients with Child-Pugh A liver function. Methods: From October 2010 to April 2014, 427 consecutive patients with primary liver cancer and preoperative Child-Pugh classification score A liver function undergoing hepatectomy were enrolled. All operations were performed by the same surgical team and under hepatic inflow occlusion with a clamp/unclamp time of 15 min/5 min. The clinical data of the patients were collected, and the risk factors for posthepatectomy liver failure were analyzed. Results: Among the 427 patients, 362 cases were male and 65 were female, with an average age of (51.1±10.4) years; 391 cases underwent surgery for hepatocellular carcinoma (HCC), 31 cases for intrahepatic cholangiocarcinoma (ICC) and 5 cases for mixed HCC and ICC. Of the cases, 86.4% (369/427) had a background of hepatitis B virus infection and 54.8% (234/427) had concomitant cirrhosis; 358 cases (83.8%) had resections of ≤3 segments and 69 cases (16.2%) had resections of ≥4 segments. Seventeen patients (4.0%) developed liver failure after hepatectomy, of whom 10 cases manifested as hyperbilirubinemia unrelated to biliary obstruction or bile leak, 6 cases had clinically apparent ascites and prolonged prothrombin time, and one case had hepatic encephalopathy and died on postoperative day 21. Univariate analysis showed that age ≥ 60 and prealbumin <170 g/L were significantly related to posthepatectomy liver failure (P=0.045, P=0.009), and multivariate analysis identified that prealbumin <170 g/L was independent risk factor for posthepatectomy liver failure (HR=3.192; 95% CI=1.185–8.601, P=0.022). Conclusion: Serum prealbumin level is an independent influential factor for posthepatectomy liver failure in patients with Child-Pugh score A liver function. So improving the nutritional status of the patients may reduce the incidence of posthepatectomy liver failure.