肝切除治疗单发巨大肝细胞癌疗效分析  

OUTCOME OF HEPATIC RESTION FOR SINGLE LARGE HEPATOCELLULAR CARCINOMA(HCC) MORE THAN 10CM IN DIAMETER

作　　者：金中强[1] 史颖弘[2] 樊嘉[2] 林智宏[1] 

机构地区：[1]萧山第一人民医院,杭州311201 [2]复旦大学附属中山医院肝癌研究所,上海200032

出　　处：《肝胆外科杂志》2006年第3期205-208,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝切除治疗单发巨大肝细胞癌的疗效及预后相关因素。方法回顾分析946例肝切除治疗单发大肝癌临床及随访资料。对279例肿瘤直径>10 cm的巨大肝癌与667例肿瘤直径大于5 cm小于等于10 cm的大肝癌中17项相关的临床病理因素进行单因素及多因素分析,比较两组生存率的差异,分析预后相关因素。结果巨大肝癌组肝切除术后的3年及5年生存率分别为29.3%及23.1%,明显低于大肝癌组的52.4%及41.9%。临床病理因素中巨大肝癌组术前γ谷氨酰转肽酶(γ-GT)水平、血清乙肝表面抗原(HBsAg)阳性率及肉眼癌栓的发生率高于大肝癌组(P<0.01)。多因素分析提示术前γ-GT水平及门静脉癌栓是巨大肝癌肝切除术后独立的预后相关因素。根据有无肉眼癌栓分组,巨大肝癌组中无癌栓组3年及5年的生存率为37.5%及29.3%,而有癌栓组3年及5年生存率只有6.9%及0%。结论肝切除是治疗单发巨大肝癌的有效手段,对无门静脉肉眼癌栓的病例,远期疗效更好。Objective To discuss the outcome and identify the risk factors for single huge hepatocellular carcinoma after partial hepatectomy. Methods The clinical data of 946 cases of single hepatocellular carcinoma large than 5 cm in diameter underwent hepatectomy were reviewed, 279 patients with single huge tumor more than 10 cm in diameter were compared with the remaining 667 patients with large tumor more than 5 cm but less than 10 cm. Univariate and stepwis logistic multivariate analyses were performed in these two groups for 17 associated risk factors. The survival was compared and the prognostic factors were identified. Results The 3 and 5-year survival for patients with huge HCC were 29. 3% and 23. 1%, which is lower than the corresponding 52.4% and 41.9% in large hcc group. The preoperative serum γ-GT level, the positive test of HBsAg and the incidence of macroscopic portal vein tumor thromobosis（PVTT） were higher in huge HCC compared with the large HCC with statistical significance. The preoperative serum γ-GT level and portal vein tumor thromobesis were identified as the independent prognostic factors for huge HCC after hepatectomy in multivariate analysis. Furthermore, the 3 and 5-year survival of patients without macroscopic tumor thrombosis in huge HCC group was 37.5% and 29. 3%, which was much more favorable than patients with PVTI＇. Conclusions The partial hepatectomy is a reasonable treatment for huge HCC. The prognosis would be better after liver resection in some selected patients without macroscopic PVTT.

关 键 词：大肝癌 肝切除 预后 

分 类 号：R657.51[医药卫生—外科学]