肝细胞癌切除术后大量腹水对预后的影响及其高风险因素研究  

Risk Factors to Large Number of Postoperative Ascites in Patients with Hepatocellular Carcinoma

作　　者：吕文平[1] 周开伦[2] 陈永亮[1] 向昕[1] 苏明[1] 童俊翔[1] 董家鸿[1] 

机构地区：[1]解放军总医院海南分院肝胆外科,三亚572013 [2]海南省人民医院肝胆外科,海口571100

出　　处：《中国医刊》2012年第10期42-46,共5页Chinese Journal of Medicine

基　　金：国家自然科学基金(30772493)

摘　　要：目的探讨肝细胞癌(HCC)切除术后出现大量腹水(LNPoA)的高风险因素及其对预后的影响。方法回顾性研究本院肝胆外科1995年1月至2009年12月实施根治性肝切除HCC 622例。KaplanMeier乘积极限法绘制生存曲线和计算生存率,log-rank检验比较生存时间差异。Logistic单因素和多因素回归分析LNPoA与22个常见临床因素的相互关系。结果本组病例LNPoA发生率为8.5%(53/622)。非LNPoA组1年、3年、5年存活率分别为80.7%、61.3%和49.3%,LNPoA组1年、3年、5年存活率分别为70.3%、38.0%和25.8%,两组生存率差异有显著性(9<0.01)。Logistic多因素回归分析发现:门静脉高压(RR:2.788;95%CI:1.538-5.052;P=0.001)、HBV-DNA(乙肝病毒脱氧核糖核酸)阳性(RR:1.860;95%CI:1.039～3.366;P=0.037)、围术期输血(RR:2.362;95%CI:1.196～4.663;P=0.013)是HCC肝切除术后大量腹水形成的独立风险因素。结论 HCC肝切除术后出现大量腹水的患者预后不良。门静脉高压、乙肝病毒脱氧核糖核酸复制、围手术期输血是HCC肝切除术后大量腹水产生的高风险因素。Objective To investigate the risk factors of large number of postoperative ascites （LNPoA） after liver re- section in patients with hepatocellular Carcinoma （HCC）. Methods A total of 622 patients with HCC were included in this retrospective study. Survival analysis was performed by log-rank test and Kaplan-Meier. In the univariate and multivariate analysis logistic regression the association of the LNPoA and 22 routine clinical parameters was ana- lyzed. Results Among the 622 patients with HCC, 8.5% of patients （3/622） had LNPoA. The 1,3,5 year surviv- al rates of patients with LNPoA were 70.3% ,38.0% and 25.8% respectively, the 1,3,5 year survival rates of pa- tients without LNPoA were 80.7% ,61.3% and 49.3% respectively （P〈0. 001 ）. Multivariate analysis shows poten- tial significant predictors of LNPoA of HCC to include ：portal hypertension （ RR：2. 788 ;95% CI ： 1. 538-5. 052 ;P= 0. 001 ）, detectable HBV DNA （ RR ： 1. 860 ;95 % CI ： 1. 039 - 3. 366 ; P = 0. 037 ）, perioperative transfusion （ RR ： 2. 362 ;95% CI ： 1. 196 - 4. 663 ;P= 0. 013 ）. Conclusion The overall survival of patients with LNPoA was signifi- candy lower than those of patients without LNPoA. Portal hypertension, detectable HBV DNA and perioperative transfusion were independent risk factors for LNPoA.

关 键 词：肝细胞 癌 腹水 肝切除 风险因素 

分 类 号：R735.7[医药卫生—肿瘤]