尾状叶与非尾状叶肝癌手术切除疗效对比观察  

Efficay of hepatocellular carcinoma surgery: a comparison between isolated resection of the caudate lobe and resection of the caudate lobe plus other part

作　　者：皮勇[1] 谢飞[1] 寇丽[1] 

机构地区：[1]湖北省襄阳市中心医院普外科,湖北襄阳441021

出　　处：《安徽医药》2014年第9期1686-1689,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的比较尾状叶肝细胞癌与非尾状叶肝细胞癌手术切除治疗效果的差异,为提高肝细胞癌的手术切除治疗效果提供临床依据。方法选择该院2008年7月—2013年10月42例尾状叶肝细胞癌切除术患者作为研究对象,并选择同期42例非尾状叶肝细胞癌患者作为对照。对两组患者的临床病理学特征、手术情况、术后复发率及生存期进行比较分析。结果尾状叶肝细胞癌患者有较长的手术时间(平均192.9 min vs 128.7 min)、较长的血管阻断时间(平均32.5 min vs 24.7 min)、较多的术中出血(平均为827.6 mL vs 431.4 mL),两组的并发症发生率没有显著差异(28.6%vs 21.4%)。两组患者均无院内死亡。尾状叶肝细胞癌组中位随访期为42.3个月,复发率为56.7%;非尾状叶肝细胞癌组中位随访期为43.3个月,复发率为41%。两组患者肿瘤复发率差异具有统计学意义,在肿瘤复发模式上无显著差异。尾状叶肝细胞癌患者1、3、5年总生存率分别为73.8%、51.9%和28.3%,对照组分别为84.2%、71.5%和49.2%(P=0.000 1)。尾状叶肝细胞癌患者1、3、5年无瘤生存率分别为60.9%、33.8%和17.6%,对照组为72.9%、60.3%和41.7%(P=0.001 2)。两组患者总生存率与无瘤生存率差异显著。结论手术切除治疗尾状叶肝细胞癌与非尾状叶肝细胞癌有着显著不同的疗效,其可能原因与尾状叶肝细胞癌手术切缘不足、术中较多出血等有关。Objective To study the differences in surgical outcomes for hepatocellular carcinoma （HCC） between isolated resection of the caudate lobe and resection of the caudate lobe plus other part .Methods Forty-two patients who have underwent hepatic resection for HCC in the caudate lobe at Xiangyang Central Hospital between July 2008 and October 2013 were chosen for study , and other 42 patients with HCC surgery not only in the caudate lobe were as controls .The clinical pathological characters , operative outcomes ,recur-rence and survival outcomes were analyzed .Results Patients with HCC in the caudate lobe had significantly longer operation time （mean,192.9 min vs 128.7 min）,longer vascular clamping time （mean,32.5 min vs 24.7 min）and more intraoperative blood loss （mean,827.6 mL vs 431.4 mL）.There was no significant difference in the complication rate （28.6%vs 21.4%）.Both groups had no hospital mortality.A median follow-up of 42.3 months after surgery,56.7%of patients with HCC in the caudate lobe developed tumor recurrence.43.3 months after surgery,41%of patients with HCC in other locations of the liver developed tumor recurrence .There were significant differences in the rates of tumor recurrence ,but there were no significant differences in tumor recurrence patterns and time intervals of recurrence between the 2 groups of patients .The 1-,3-,and 5-year overall survival rates were 73.8%,51.9%,and 28.3%, respectively,for patients with HCC in the caudate lobe and 84.2%,71.5%,and 49.2%,respectively,for patients with HCC in other locations of the liver.The 1-,3-,and 5-year disease-free survival rates were 60.9%, 33.8%and 17.6%,respectively,for patients with HCC in the caudate lobe and 72.9%, 60.3%and 41.7%,respectively,for patients with HCC in other locations of the liver .The differ-ences in overall and disease-free survival rates between the 2 groups were significant（P=0.000 1 and P=0.001 2）.Conclusions With adequate surgical resection ,HCC in the caudate lobe had significantly different survi

关 键 词：肝癌 尾状叶 肝切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤]