肝硬化肝癌患者手术切除预后影响因素的回顾性研究

发布时间：2018-03-28 10:32

  本文选题：原发性肝癌　切入点：肿瘤大小　出处：《第三军医大学学报》2017年20期

【摘要】：目的探讨合并肝硬化的不同大小肝癌患者临床资料特点及肝切除术近远期预后的影响因素。方法回顾性分析第三军医大学西南医院2008-2012年期间因肝癌而接受肝脏切除手术且具有肝硬化的连续患者资料共703例。收集患者临床病理资料并进行随访。对可能影响近、远期预后的因素分别进行Logistic及Cox回归分析。结果 703例患者中,男性638例,女性65例。其中,肿瘤最大直径5 cm的患者(小肝癌组,ST组)280例(39.8%),肿瘤最大直径≥5 cm的患者(大肝癌组,LT组)423例(60.2%)。与ST组患者比较,LT组患者术前甲胎蛋白、天门冬氨酸氨基转移酶(AST)及脉管癌栓发生率较高,但白蛋白及血小板较低。术中资料表明LT组患者复杂手术比例、术中失血量、肝门阻断时间及手术时间都较高。而LT组患者术后并发症的总发生率也较高(35.0%vs 27.1%,P=0.029)。多因素分析显示,在ST组中,复杂手术(OR:2.755,95%CI:1.196~6.344,P=0.017)是独立的危险因素,而白蛋白水平低于35 g/L(OR:4.049,95%CI:2.105~7.752,P0.01)与手术时间240 min(OR:3.044,95%CI:1.912~4.847,P0.01)是LT组独立的危险因素。远期预后分析显示:LT组患者无瘤生存时间(progression-free survival,PFS)和总生存时间(overall-survival,OS)均比ST组短(P0.01)。多因素分析显示,在ST组中,癌栓是影响PFS的独立危险因素;而Child-Pugh B级、癌栓和复杂手术是影响OS的独立危险因素。在LT组中,癌栓和手术时间240 min均为影响PFS的独立危险因素;而AST40 U/L和癌栓是影响OS的独立危险因素。结论直径5 cm的小肝癌较之直径≥5 cm的大肝癌患者有着更高的近、远期生存率。而选择无癌栓的大肝癌病例,改善术前白蛋白、转氨酶水平,提高手术熟练度及合理使用手术器械[如射频消融辅助(radiofrequency ablation assist,RFA)]以缩短手术时间,可以降低术后并发症并改善大肝癌手术治疗的预后。
[Abstract]:Objective to investigate the clinical data and prognostic factors of hepatectomy in patients with liver cancer of different size and size complicated with cirrhosis. Methods Hepatectomy was performed in Southwest Hospital of the third military Medical University from 2008 to 2012. Methods Hepatectomy was performed in Southwest Hospital of the third military Medical University from 2008 to 2012. There were 703 consecutive patients with cirrhosis except surgery. The clinicopathological data of the patients were collected and followed up. The long-term prognostic factors were analyzed by Logistic and Cox regression analysis. Results among 703 patients, 638 were male and 65 were female. There were 280 cases in St group with tumor maximum diameter of 5 cm and 280 cases with tumor maximum diameter 鈮，

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