伴有肝硬化门静脉高压症的肝细胞癌患者肝切除术的并发症和预后分析  

Morbidity and prognosis after hepatic resection for hepatocellular carcinoma in portal hypertensive cirrhotic patients

作　　者：吴力群[1] 张顺[1] 郭卫东[1] 曹景玉[1] 王祖森[1] 胡维昱[1] 韩冰[1] 张斌[1] 邱法波[1] 

机构地区：[1]青岛大学医学院附属医院肝胆外科,山东省266003

出　　处：《中华普通外科杂志》2013年第7期492-496,共5页Chinese Journal of General Surgery

摘　　要：目的探讨伴有门静脉高压症（portal hypertension，PH）的肝硬化相关的原发性肝细胞癌（hepatocellular carcinoma，HCC）患者R0切除的并发症及预后。方法回顾性分析青岛大学医学院附属医院2001年1月至2010年12月获R0切除的肝硬化相关原发性HCC患者523例的临床资料、术后并发症和死亡率和随访结果。结果523例患者中有146例（27．9％）伴有PH（PH组），377例无PH的证据（72．1％，无门组）；二组的术前资料对比分析显示，PH组患者术前TACE治疗、Child—Pugh B级、血清白蛋白值〈35g／L、输血和肿瘤直径≤5cm者显著多于无PH组（P〈0．05）。PH组和无PH组患者的手术死亡率为3．4％（死因均为肝病相关）和0．5％（Х^2=6．676，P=0．010），术后并发症的发生率分别为28．1％和14．3％（P=0．001），PH组主要是肝病相关并发症（腹水〉800ml／d、肝功能不全和肝衰竭）高。去除手术死亡的517例患者中，PH组和无PH组患者获R0切除术后的5年生存率分别为46．8％和54．6％（P=0．047），无瘤生存率分别为37．0％和38．0％（P=0．725）；Kaplan—Meier分析显示伴有PH、AFPI〉20ng／ml、肿瘤直径〉5cm、非孤立型HCC、肝切除范围超过1个肝段和输血的患者其生存率显著降低（P〈0．05）；Cox回归分析显示肿瘤直径〉5cm和非孤立型HCC是影响肝硬化背景HCC患者R0切除术后的独立危险因素（P〈0．05）。结论伴有门静脉高压症的HCC患者R0切除术后的并发症和手术死亡率显著高于无PH的患者，肝病相关并发症是主要因素。虽然PH组HCC患者R0切除术后的生存时间显著低于无PH组，但伴有PH不是影响HCC患者R0切除术后长期生存的独立危险因素。Objective To evaluate the morbidity and prognosis after curative hepateetomy for hepatocellular carcinoma （HCC） in portal hypertensive （PH） cirrhofics. Method Clinical data of 523 patients with cirrhosis-related HCC from January 2001 to December 2010 undergoing hepatectomy at the Dept. of Hepatobiliary Surgery, the Affilated Hospital of Medical College, Qingdao University were studied retrospectively. Results There were 146 （27.9%） patients with PH （PH group） and 377 （72. 1% ） patients without PH （non-PH group）. Patients with TACE before hepateetomy, Child-Pugh class B, serum albumin 〈 35 g/L, b]ood transfusion and tumor size ≤5 cm in PH group were more than that in non-PH group. The mortality within 30 day after resection was 3.4% in PH group and 0. 5% in non-group （ P 〈 0. 05 ） , the cause of death in PH group was related with liver disease. The postoperative morbidity was 28.1% and 14. 3% in PH group and non-PH group （P 〈0. 001 ）. The overall survival （OS） rate after R0 resection was 46.8% and 54. 6% in patients with PH and without PH （ P = 0. 047 ）, the disease-free survival was 37.0% and 38.0% （ P = 0. 725 ）. By Kaplan-Meier analysis： alcoholism, with PH, AFP≥20 ng/ml, tumor size 〉5 cm and non-solitary type HCC was important factors for OS; tumor size 〉 5 cm and non-solitary type HCC was independent predictors for survival. Conclusions The mortality and morbidity in cirrhosis-related HCC patients with PH after R0 resection was higher than that in patients without PH, with most being related to liver disease. PH was not an independent predictor for cirrhosisrelated HCC patients＇ survival after R0 resection, shorter than the patients without PH.

关 键 词：癌 肝细胞 高血压 门静脉 肝切除术 手术后并发症 预后 

分 类 号：R735.7[医药卫生—肿瘤]