肝癌破裂出血的临床治疗和预后研究

发布时间：2021-04-07 05:15

　　目的:通过倾向得分匹配（PSM）的方法,证实在肝癌破裂出血的病人中,肝切除相比较于非手术治疗是否可以获得更好的预后。方法:我中心共有216患肝癌破裂病人被纳入研究。其中,130例病人接受了手术治疗（急诊或者延期手术）,86例病人接受了非手术治疗。倾向得分匹配被用于校正两组病人的基线特征差异。并进行影响长期生存的单因素和多因素的危险因素模型分析。结果:PSM分析前,手术组和非手术组的病人的中位生存期（MST）分别为13.7（IQR 7.2–35.4）月、2.5（0.5–7.4）月。单因素（HR 3.756,95%CI 2.766-5.101;P<0.001）和多因素（HR 3.141,95%CI 2.198-4.488;P<0.001）生存分析都证实,非手术治疗方式预示着较差的总体生存。PSM后,每组分别有35例病人,两组基线特征均衡性好。手术组病例（15.0月）的中位总体生存期优于非手术组病例（3.2月）（HR 3.029,95%CI 1.745-5.258;P<0.001）。多因素生存分析显示,非手术治疗是致使不良预后的危险因素（HR 2.792,95%CI 1.5... 

【文章来源】：华中科技大学湖北省 211工程院校 985工程院校 教育部直属院校

【文章页数】：94 页

【学位级别】：博士

【部分图文】：

肝部分切除组与非手术组(TAE+保守治疗)倾向评分匹配前(A)和后(B)的总体生存率曲线。

这228例病人的流行病特征、临床指标、实验室检查见表1。本研究共纳入了206例男性,22名女性。201例病人合并乙肝,仅有17例病人合并丙肝。肝切除组、手术止血组、TAE组和保守治疗组四组病人的平均年龄分别为:46.3±11.5岁,53.1±10.7岁,47.8±12.9岁,50.8±14.0岁。肝切除组、手术止血组、TAE组和保守治疗组四组病人的中位生存时间分别为:13.1月,4.9月,3.1月,0.6月。1.5.2 PSM前后病人基线特征比较

共有142例肝癌破裂病人接受了手术治疗,其中有12例仅进行了出血肿瘤的手术止血而无法行根治性切除,如微波固化治疗、肝动脉结扎、缝扎治疗。共有130例病人行肝部分切除术,其中接受急诊肝切除(EmPH)治疗病人共计30例,接受延期肝切除(SPH)治疗共100例。而SPH又包含SEPH治疗67例,SDPH治疗33例(图1)。病人的流行病和临床病理学体征见表1。有两例病人行TAE治疗后出血未止,随即行EmPH。有8例入院前曾于外院获得首次手术治疗,其中3例外院治疗后止血无效,遂于我院行EmPH,另有5例经外院止血有效后再来我院行SPH。在130例手术病人中,有126病人(96.9%)获得了R0根治切除。接受肝切除术病人的术中平均肝血流阻断时间为13.5±7.4min。术后并发症发生率为59.2%(n=77),其中大部分都处于Clavien-Dindo并发症分级的I-II级(n=61)。

【参考文献】：
期刊论文
[1]Liver cancer incidence and mortality in China: Temporal trends and projections to 2030[J]. Rongshou Zheng,Chunfeng Qu,Siwei Zhang,Hongmei Zeng,Kexin Sun,Xiuying Gu,Changfa Xia,Zhixun Yang,He Li,Wenqiang Wei,Wanqing Chen,Jie He.  Chinese Journal of Cancer Research. 2018(06)
[2]《原发性肝癌诊疗规范》（2017版）解读[J]. 张志伟,陈孝平.  临床外科杂志. 2018(01)
[3]肝癌切除技术创新与发展[J]. 陈孝平,张万广.  中华普外科手术学杂志(电子版). 2017(05)
[4]Hydrochloric acid-enhanced radiofrequency ablation for treating a large hepatocellular carcinoma with spontaneous rapture:a case report[J]. Ru-Hai Zou,Yang-Kui Gu,Fei Gao,Tian-Qi Zhang,Wang Yao,Xiong-Ying Jiang,Yan-Yang Zhang.  Chinese Journal of Cancer. 2017(01)
[5]以手术治疗为主的肝癌个体化综合治疗[J]. 陈孝平,朱鹏.  中国实用外科杂志. 2016(06)
[6]Hepatic resection beyond barcelona clinic liver cancer indication:When and how[J]. Mattia Garancini,Enrico Pinotti,Stefano Nespoli,Fabrizio Romano,Luca Gianotti,Vittorio Giardini.  World Journal of Hepatology. 2016(11)
[7]Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study[J]. Jing Li,Liang Huang,Cai-Feng Liu,Jie Cao,Jian-Jun Yan,Feng Xu,Meng-Chao Wu,Yi-Qun Yan.  World Journal of Gastroenterology. 2014(27)
[8]Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers[J]. Long-Hao Sun,Hong-Qiu Han,Peng-Zhi Wang,Wei-Jun Tian.  World Journal of Gastroenterology. 2013(03)
[9]Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma[J]. Qian Zhu,Jing Li,Jian-Jun Yan,Liang Huang,Meng-Chao Wu,Yi-Qun Yan.  World Journal of Gastroenterology. 2012(48)
[10]Grading and staging of hepatic fibrosis,and its relationship with noninvasive diagnostic parameters[J]. Lun-Gen Lu Min-De Zeng Yi-Min Mao Ji-Qiang Li De-Kai Qiu Ai-Ping Cao, Shanghai Institute of Digestive Disease, Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China Mo-Bin Wan Cheng-Zhong Li, Department of Infectious Diseases, Changhai Hospital, Shanghai 200433, China Jun Ye, Department of Infectious Diseases, Putou District Central Hospital, Shanghai 200062, China Xiong Cai, Department of Infectious Diseases, Changzheng Hospital, Shanghai 200003, China Cheng-Wei Chen, Shanghai Liver Diseases Research Center, Nanjing Military Command, Shanghai 200233, China Ji-Yao Wang, Department of Gastroenterology, Zhongshan Hospital, Shanghai 200032, China Shan-Ming Wu, Shanghai Infectious Hospital, Shanghai 200085, China Jin-Shui Zhu, Department of Gastroenterology, Shanghai NO.6 Hospital, Shanghai 200233, China Xia-Qiu Zhou, Department of Infectious Diseases, Ruijin Hospital, Shanghai 200025, China.  World Journal of Gastroenterology. 2003(11)



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