食管静脉曲张对原发性肝癌合并肝硬化根治性切除术预后的影响  

Effects of esophageal varices on the prognosis of patients with hepatocellular carcinoma and hepatic cirrhosis after radical resection

作　　者：吴力群[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,266003

出　　处：《中华消化外科杂志》2013年第11期832-837,共6页Chinese Journal of Digestive Surgery

摘　　要：目的探讨食管静脉曲张（EV）对原发性肝癌合并肝硬化患者根治性切除术预后的影响。方法回顾性分析2001年1月至2010年12月青岛大学医学院附属医院收治的455例原发性肝癌合并肝硬化患者的临床资料和随访结果。61例患者术前影像学检查出现EV为EV组，394例无EV表现的为无EV组，比较两组患者的手术情况及预后。所有患者术后3个月内每月复查1次，以后每3个月复查1次，随访时间截至2012年12月或患者死亡。计量资料或率的比较采用，检验；Kaplan—Meier法绘制生存曲线，生存率的比较采用Log—rank检验，多因素分析采用COX回归风险模型。结果患者均行根治性肝切除术，其中行肝切除＋贲门周围血管离断术4例，脾切除术18例（包括联合贲门周围血管离断术3例）。EV组患者手术切缘距肿瘤距离〈0．5cm、脾切除、术中出血量≥1000ml和术中输血患者比例显著多于无EV组，两组比较，差异有统计学意义（X2=7．113，18．209，5．527，14．298，P〈0．05）；而两组肝切除范围〉1段、解剖性肝切除、术中进行人肝血流阻断的患者比例比较，差异无统计学意义（X2=0．591，0．124，1．412，P〉0．05）。455例患者中8例发生上消化道出血，患者均无门静脉癌栓存在。EV组和无EV组患者上消化道出血发生率分别为9．84％（6／61）和0．51％（2／394），两组比较，差异有统计学意义（X2=26．611，P〈0．05）。患者均获得随访，中位随访时间为39．0个月（3．0～136．3个月）。455例患者中共有218例死亡，其中Ev组死亡37例，无EV组死亡181例。EV组患者因肝癌、肝病和其他原因死亡者所占比例分别为67．57％（25／37）、29．73％（11／37）和2．70％（1／37），而无EV组患者所占比例分别为86．19％（156／181）、6．63％（12／181）和7．18％（13／181），两组比较，差异有统计学意义（X2=17．780�Objective To investigate the effects of esophageal varices （EV） on the incidence of compli- cations and prognosis of patients with hepatocellular carcinoma （HCC） and hepatic cirrhosis after radical resec- tion. Methods The clinical data of 455 patients with HCC and hepatic cirrhosis who were admitted to the Affiliated Hospital of Qingdao University from January 2001 to December 2010 were retrospectively analyzed. All the patients were divided into the EV group （61 patients） and non-EV group （394 patients） according to the results of pre-operative imaging examination. The intraoperative condition and the prognosis of the patients in the 2 groups were compared. All the patients were re-examined every month within the first 3 months after operation, and then they were re-examined every 3 months thereafter. The follow-up was ended till December, 2012 or the day of patients＇ death. Comparison of the measurement data and rates was done by chi-square test; the survival curve was drawn by Kaplan-Meier method, and the survival was analyzed using the Log-rank test; multivariate analysis was done by Cox proportional hazard regression model. Results All the patients received radical hepatectomy. Four patients received hepatectomy ＋ pericardial devascularization, 18 received hepatectomy ＋ splenectomy （3 of them received pericardial devascularization）. The ratios of patients with the distance between the resection margin and the tumor 〈 0.5 cm, splenectomy, volume of intraoperative blood loss≥1000 ml and intraoperative blood transfusion in the EV group were significantly greater than those in the non-EV group 0（2=7. 113, 18.209, 5. 527, 14. 298, P 〈0.05）. There was no significant difference in the ratio of patients who received multi-segmentectomy, anatomical hepatec- tomy, intraoperative inflow occlusion between the 2 groups （XZ= 0. 591,0. 124, 1. 412, P 〉 0.05）. Eight patients were complicated with upper gastrointestinal bleeding, while no portal vein tumor thrombus was detected in a

关 键 词：肝肿瘤 肝硬化 静脉曲张 食管 肝切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤]