原发性肝癌切除术中Pringle Maneuver时间对肿瘤复发的影响

发布时间：2018-05-22 11:54

本文选题：缺血再灌注损伤 + Pringle　；参考：《吉林大学》2017年硕士论文

【摘要】：研究背景和目的:原发性肝癌是世界上最常见的恶性肿瘤之一,其肿瘤相关死亡率在我国位居第二位。手术切除是目前治疗原发性肝癌的首选方法,尽管近年来手术技术的进步提高了肝癌切除率,但术后亦复发转移导致肝癌预后不良。国内外临床研究表明,肝癌根治性切除术后3年复发率为40%-50%,5年转移复发率为60-70%,5年总体生存率仅为20-50%。因此,如何预防或避免肝癌术后复发是肝脏外科面临的巨大挑战。肝癌切除术中,肝门阻断术(Pringle Maneuver)是临床常用的阻断入肝血流的有效方法。虽然可以有效降低术中出血量,但是不可避免的引起肝脏缺血再灌注损伤(IRI),进而损害残肝增殖修复能力。实验研究表明,IRI对血液中残留的肿瘤细胞的迁移、黏附、定植、生长等过程均有重要影响,与肝癌术后的复发、转移关系密切。随着Pringle Maneuver时间的延长,IRI加重,但是目前尚未有明确的Pringle Maneuver时间对肿瘤复发率影响的报道。因此,我们对本中心近5年实施的肝癌根治性切除术的病例进行了回顾性研究,以探讨Pringle Maneuver所致的肝IRI时间与肿瘤复发的关系。材料与方法:回顾性分析120例原发性肝癌患者临床资料,来源于吉林大学中日联谊医院医院2010年1月至2014年12月期间进行根治性切除术的原发性肝癌患者。统计患者Pringle Maneuver阻断时间,无瘤生存时间,总体生存时间,和其他可能影响结果的预后因素。根据研究内容,制定并输写合格的病例调查表,通过统一随访程序获得结局资料。最后对数据用SPSS21.0软件进行统计分析。结果:120例进行根治性切除的原发性肝癌患者中,男性96例,女性24例,男女比例为4:1。年龄范围为20-73岁,平均年龄54岁。非Pringle Maneuver术式的38例(占总人数32%),进行Pringle Maneuver术式的82例(占总人数68%),其中Pringle Maneuver时间"f15min有43例(占Pringle Maneuver组52%),Pringle Maneuver时间15min有39例(占Pringle Maneuver组48%)。术后5年内肿瘤复发的患者共75例,占总人数比例为63%。根据Pringle maneuver时间的不同分为三组Pringle maneuver为0,"f15,15分钟,三组平均无瘤生存时间分别是30,29,20个月。Pringle maneuver为0,"f15,15分钟三组的平均总生存时间分别是43,42,30个月。统计数据发现Pringle Maneuver阻断时间超过15分钟时会增加肝癌复发的风险(P0.001),而Pringle Maneuver小于15分钟对肝癌复发无明显影响。Pringle Maneuver阻断时间超过15分钟的患者,其总体生存时间和无瘤生存时间均小于对照组(P0.001)。结论:术中长时间进行Pringle Maneuver会增加肝癌患者术后肿瘤复发的风险,缩短患者总生存时间和无瘤生存时间。其他影响术后肝癌复发的独立危险因素有:AFP水平20ng/ml,肿瘤大小,多发肿瘤,肿瘤多叶,肿瘤无包膜,和肿瘤分级III IV,微血管浸润。
[Abstract]:Background and objective: primary liver cancer is one of the most common malignant tumors in the world. Surgical resection is the first choice in the treatment of primary liver cancer at present. Although the progress of surgical technique has improved the resection rate of liver cancer in recent years, recurrence and metastasis also lead to poor prognosis of liver cancer. The clinical studies at home and abroad showed that the recurrence rate was 40-50 in 3 years after radical resection of liver cancer, 60-70 in 5 years of metastasis, and 20-50 in overall survival rate of 5 years. Therefore, how to prevent or avoid postoperative recurrence of liver cancer is a huge challenge for liver surgery. Pringle Maneuvere is an effective method to block hepatic blood flow in hepatectomy. Although it can effectively reduce the amount of intraoperative bleeding, it inevitably leads to liver ischemia reperfusion injury, thus impairing the ability of residual liver proliferation and repair. The experimental study showed that IRI had an important effect on the migration, adhesion, colonization and growth of residual tumor cells in the blood, and was closely related to the recurrence and metastasis of liver cancer after operation. With the prolongation of Pringle Maneuver time, however, there is no clear report on the effect of Pringle Maneuver time on tumor recurrence rate. In order to investigate the relationship between the time of liver IRI induced by Pringle Maneuver and the recurrence of liver cancer, we retrospectively studied the cases of radical resection of hepatocellular carcinoma (HCC) performed in our center in recent 5 years. Materials and methods: the clinical data of 120 patients with primary liver cancer (PHC) were retrospectively analyzed. The clinical data were collected from the patients undergoing radical resection of HCC from January 2010 to December 2014 in the Sino-Japanese Friendship Hospital of Jilin University. Pringle Maneuver blocking time, tumor-free survival time, total survival time, and other prognostic factors that may affect the outcome were counted. According to the content of the study, a qualified case questionnaire was developed and written, and the outcome data were obtained through a unified follow-up procedure. Finally, the data are analyzed by SPSS21.0 software. Results among 120 patients with primary liver cancer undergoing radical resection, 96 were male and 24 were female, with a ratio of 4: 1. The age range was 20 to 73 years, with an average age of 54 years. There were 38 cases of non Pringle Maneuver operation (32 cases) and 82 cases of Pringle Maneuver operation (68 cases). Among them, 43 cases were Pringle Maneuver time "f15min" (39 cases in Pringle Maneuver group) and 39 cases in Pringle Maneuver group (48 cases in Pringle Maneuver group). There were 75 cases of tumor recurrence within 5 years after operation, accounting for 63% of the total number of patients. According to the difference of Pringle maneuver time, there were three groups with Pringle maneuver of 0, "f15t 15 minutes, the mean tumor-free survival time of the three groups was 30 ~ 29m, 20 months. Pringle maneuver was 0," the average total survival time of f1515 minutes group was 43 ~ 42and 30 months, respectively. Statistical data showed that Pringle Maneuver blocking time more than 15 minutes increased the risk of liver cancer recurrence (P 0.001), while Pringle Maneuver less than 15 minutes had no significant effect on HCC recurrence. Pringle Maneuver blocking time was more than 15 minutes in patients with HCC recurrence. The overall survival time and tumor-free survival time of the control group were smaller than that of the control group (P 0.001). Conclusion: prolonged intraoperative Pringle Maneuver may increase the risk of tumor recurrence and shorten the total survival time and tumor-free survival time. Other independent risk factors for recurrence of liver cancer after operation were 20 ng / ml of III, tumor size, multiple tumors, multilobular tumor, no capsule, and tumor grade III IV, microvessel infiltration.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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