肝细胞肝癌840例临床分析  

Analysis of the clinical features and treatment outcomes of 840 patients with hepatocellularcarcinoma

作　　者：颜见[1] 姚志成[1] 钟跃思[1] 李明亮[1] 邓美海[1] 

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2012年第1期31-35,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家青年自然科学基金项目(81000177);广东省科技计划项目(2010B031600215)

摘　　要：目的探讨肝细胞肝癌(肝癌)与乙型肝炎病毒(HBV)感染的相关性及不同治疗方法的疗效。方法回顾分析2001年1月至2006年6月中山大学附属第三医院收治的840例肝癌患者的临床资料。患者均签署知情同意书,符合医学伦理学规定。收集患者合并肝硬化情况、肿瘤大小与数目、肝功能、肿瘤临床分期、HBV感染等相关资料,分析肝癌临床特征及其与HBV感染的关系。将病例按不同治疗方式分为手术切除组、肝移植组、消融和(或)介入组(综合治疗组)、保守治疗组,分别为191例、107例、349例、193例,分析4组患者的存活情况。结果 840例肝癌患者中合并肝硬化675例,占80.4%;小肝癌210例,占25%;单发肿瘤550例,占65.5%;肝功能Child￣Pugh分级A级429例,占51.1%,B级287例,占34.2%,C级124例,占14.8%;巴塞罗那临床肝癌分期B^D期(中晚期)共725例,占86.3%。乙型肝炎表面抗原(HBsAg)阳性者795例,占94.6%。606例肝癌患者接受了乙型肝炎病毒脱氧核糖核酸(HBV￣DNA)定量检测,定量检测阳性者488例,占80.5%;肝癌合并肝硬化患者的HBV￣DNA含量明显高于无合并肝硬化的肝癌患者(t=2.32,P<0.05)。手术切除组1、2、5年存活率分别为85%(163/191)、75%(144/191)及31%(60/191);肝移植组相应为72%(77/107)、62%(67/107)、31%(33/107);综合治疗组相应为71%(248/349)、50%(176/349)、10%(34/349);保守治疗组相应为8%(16/193)、3%(7/193)、0。结论 HBV感染是导致肝癌发生的主要原因,大多数患者合并肝硬化。手术切除是治疗肝癌的首选方法,肝移植亦可以取得良好的治疗效果,对于不能手术切除和肝移植患者,积极综合治疗不失为有效的治疗措施,保守治疗效果较差。Objective To analyze the relationship between hepatocellular carcinoma （HCC） and hepatitis B virus （HBV） and treatment effect of HCC. Methods Clinical data of 840 cases with HCC in the Third Affiliated Hospital of Sun Yat-sen University from January 2001 to June 2006 were collected and analyzed retrospectively, which included liver cirrhosis complication, tumor size and number, liver function, clinical staging, HBV infection and other relevant information. Local ethical committee approval had been received and that the informed eoneent of all participating subjects was obtained. The patients were divided into 4 groups according to different treatment： 191 cases with surgical resection, 107 cases with liver transplantation, 349 cases with ablation and （or） intervention treatment （comprehensive treatment）, and 193 cases with conservative treatment. The effects of the four treatment groups were analyzed. Results Among all patients, 675 cases had liver cirrhosis, which accounted for 80.4%. Two hundred and ten cases were diagnosed as small HCC, which accounted for 25%. Five hundred and fifty cases developed a single tumor, which accounted for 65.5%. For the Child-Pugh grade, 429 cases （51.1%） were grade A, 287 cases （34.2%） were grade B, and 124 cases （14.8%） were grade C. According to Barcelona clinical liver cancer （BCLC） staging, 725 cases （86.3%） were in B - D stage （middle-late stage）. Seventy hundred and ninety cases （94.6%） were hepatitis B surface antigen （HBsAg） positive. Among 606 cases of HCC patients receiving the hepatitis B virus-deoxyribonucleic acid （HBV-DNA） quantitative test, 488 cases were positive, which accounted for 80.5%. Serum HBV-DNA concentration of HCC patients with liver cirrhosis was significantly higher than that of HCC patients without liver cirrhosis （t=2.32, P〈0.05）. The 1, 2 and 5 year survival rates in surgical resection group were 85%（163/191）, 75%（144/191）and 31%（60/191） respectively, 72%（77/107）, 62% （67

关 键 词：肝细胞肝癌 乙型肝炎病毒 肝硬化 根治性肝切除术 肝移植 综合治疗 生存分析 

分 类 号：R735.7[医药卫生—肿瘤]