肝癌破裂出血的疗效及预后因素分析  

Analysis on curative effect and influencing factors on prognosis of spontaneous rupture of hepatocellular carcinoma

作　　者：戴珏[1] 郭涛[1] 许继凡[1] 皮亮[1] 罗诗樵[1] 

机构地区：[1]重庆医科大学附属第一医院,重庆400016

出　　处：《现代中西医结合杂志》2014年第24期2638-2640,2658,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：重庆市卫生局医学科研项目(2008-2-02)

摘　　要：目的探讨肝癌破裂出血的治疗方法及疗效,并分析影响肝癌破裂出血患者术后生存的独立因素。方法回顾性分析56例肝癌破裂出血患者的临床和随访资料,其中保守治疗25例,根治性手术治疗18例,姑息性手术治疗8例,肝动脉栓塞(TAE)5例,比较各组的临床疗效。并以中位生存期(MST)为切割点将根治性治疗组分成2组,对影响根治性手术预后的相关因素行单因素和多因素分析。结果根治性手术组6,12,36个月生存率及MST明显优于保守治疗组、姑息性手术治疗组及TAE组(P均<0.01)。COX回归模型提示肿瘤直径>7 cm、高功能状态(PS)评分是影响根治性手术组患者预后的独立因素。结论急诊行根治性手术是治疗肝癌破裂出血的有效方法,其疗效优于保守治疗、姑息性手术治疗及TAE治疗。而肿瘤直径>7 cm及高PS评分为术后独立的不良预后因素。Objective It is to approach the methods and curative effect for spontaneous rupture of hepatocellular carcinoma, and analyze the influencing factors on postoperative survival of patients with bleeding and rupture of hepatocellular carcinoma. Methods The elinical data of 56 patients with bleeding and ruptures of hepatocellular carcinoma were retrospective analzed, that include 25 cases with conservative treatment, 18 cases with radical surgery, 8 patients with Palliative surgery and 5 patients with transarterial embolization （TAE）. The clinical curative effect was compared. The patients received radical surgery were divided into two group according to median survival time （MST） , and the influencing factors on postoperative survival were analyzed by single factor and Multiple factor analysis. Results The 6 - , 12 - , 36 - month survival rate and MST in the radical surgery group were markedly better than that in the conservative treatment group, palliative surgery group and TAE group （ P 〈 0.01 ）. A multivariate analysis showed a maximum tumor size exceeding 7 cm and Performance Status （PS） were the independent risk factors for the prognosis of patient with radical surgery. Conclusion Emergency radical surgery is an ef- fective method for the treatment of spontaneous rupture of hepatocellular carcinoma, it is better than conservative treatment, palliative surgery and TAE. The maximum tumor size 〉 7 cm and PS score are the independent factors of poor prognosis for radical surgery.

关 键 词：肝癌 破裂出血 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]