肝细胞癌自发破裂的预测和临床预后  

Risk factors of spontaneous rupture of hepatocellular carcinoma and prognostic factors of long-term sur-vival

作　　者：朱倩[1] 晏建军[2] 张向化[2] 曹杰[2] 黄亮[2] 李静[2] 沈军[2] 严以群[2] 

机构地区：[1]湖北省荆门市第一人民医院肝胆外科,448000 [2]第二军医大学东方肝胆外科医院肝外一科

出　　处：《中华肝胆外科杂志》2012年第11期846-850,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的研究影响肝癌自发破裂的危险因素及预后因素，评估选择性一期肝切除的治疗效果。方法从2002年4月至2006年11月在东方肝胆外科医院确诊为肝癌的4209例患者中，有200例肝癌自发破裂。回顾性分析200例自发破裂患者的临床特点和预后因素。评估不同治疗手段的预后，并与随机选取的202例同期未发生破裂的肝癌患者进行对比。结果多因素回归分析显示肝硬化、高血压、血管癌栓、肝外侵犯及肿瘤大于5cm是肝癌自发破裂的预测因素。在200例肝癌自发破裂患者中，105例行肝切除治疗、33例肝动脉插管化疗栓塞（TACE），62例保守治疗。所有肝癌破裂患者的中位生存时间为6个月（1-72个月），1、3、5年总体生存率分别为32．5％、10％和4％。肝切除组患者中位生存时间为12个月（1-72个月），TACE组为4个月（1-30个月），而保守组为1个月（1-19个月）。行肝切除的肝癌破裂患者（105例）1、3、5年总体生存率分别为57．1％、19．0％和7．6％，而同期未破裂肝切除肝癌患者（98例）1、3、5年总体生存率分别为77．1％、59．8％和41．2％（P〈0．001）。结论对于伴有肝硬化、高血压、血管癌栓、肝外侵犯及肿瘤大于5cm的肝癌患者，应警惕肝癌自发破裂的高风险。选择性一期肝切除治疗的肝癌破裂患者能够获得长期生存，尽管其总体预后较肝癌未发生破裂患者差。Objective To determine the risk factors of ruptured hepatocellular carcinoma （HCC） and to study the prognostic factors of long-term survival. Methods Of the 4209 patients with HCC diagnosed and treated at the Eastern Hepatobiliary Surgery Hospital from Apt 2002 to Nov 2006, 200 patients （4.8%） presented with ruptured HCC. These patients were studied retrospectively and the results of treatment were evaluated and compared with a randomly selected group of 202 pa tients who had no history of rupture and were treated during the study period. Results On multivari- ate logistic regression analysis, co-existing hypertension and cirrhosis, tumor size ~5 cm, vascular thrombus and extrahepatic invasion were predictors of spontaneous rupture of HCC. For the 200 pa- tients with spontaneous rupture of HCC, 105 patients underwent elective one-stage hepatic resection, 33 received transcatheter arterial chemoembolization （TACE）, and 62 were treated conservatively. The median survival time （MST） for patients with spontaneous rupture of HCC was 6 months （range, 1-72 months）, and the overall survival rates at 1 , 3- and 5-year were 32.5%, 10% and 4%, re- spectively. The MST was 12 months （range, 1-72 months） in the surgical group, 4 months （range, 1-30 months） in the TACE group and 1 month （range, 0-19 months） in the conservative group. The 1-, 3 and 5-year overall survival rates in patients with ruptured HCC who received partial hepa- tectomy were 57.1%, 19.0% and 7.6%, respectively, compared with 77.1%, 59.8% and 41.2% in 98 patients who underwent partial hepatectomy for HCC without rupture （P〈0. 001）. Conclusions For patients with HCC who had underlying of hypertension and cirrhosis, extrahepatic invasion and tumor size ~5 cm, there was a high propensity to rupture. Prolonged survival could be achieved in se- lected patients who received one-stage partial hepatectomy, although the survival results were inferior to the patients had no rupture.

关 键 词：肝细胞癌 破裂 危险因素 预后 肝切除 

分 类 号：R735.7[医药卫生—肿瘤]