围术期使用静脉止血剂降低早期肝癌切除患者术后无瘤生存时间及总生存率  

Perioperative application of intravenous hemostatics is associated with poor overall and recurrence-free survival of patients with early stage hepatocellular carcinoma following curative resection

作　　者：费国雄[1] 崔龙久 杨立群[1] 俞卫锋[1] 

机构地区：[1]第二军医大学东方肝胆外科医院麻醉科,上海200438 [2]第二军医大学东方肝胆外科医院特殊二科,上海200438

出　　处：《第二军医大学学报》2014年第7期739-744,共6页Academic Journal of Second Military Medical University

摘　　要：目的探讨术中使用静脉止血剂对肝癌切除术后的远期生存与复发的影响。方法选择2005至2007年本院手术切除的肝癌患者中肿瘤直径〈5cm的T1-2N0M0期,肝功能Child-Pugh评分A、B级,病理切缘阴性者,共504例。用逐步回归法Cox模型分析各因素对患者远期生存复发的影响,Kaplan-Meier法分析使用静脉止血剂对患者总生存时间和无瘤生存时间的影响。结果所有患者中位随访时间为64（7~72）个月,504例患者中围术期使用过静脉止血剂者326例,未使用任何静脉止血剂者178例,使用止血剂组5年总生存率较未使用止血剂组低（61.04%vs 75.28%,P=0.002）;使用止血剂组患者5年无瘤生存率较未使用止血剂组患者低（49.08%vs 61.80%,P=0.001）。逐步回归法Cox分析表明,围术期使用静脉止血剂是影响患者术后总生存（RR=1.872,95%CI 1.298~2.702;P=0.001）和无瘤生存（RR=1.523,95%CI 1.136~2.043;P=0.005）的独立危险因素。结论围术期使用静脉止血剂可能会降低肝癌切除患者术后总生存时间和无瘤生存时间。Objective To investigate the effects of perioperative application of intravenous hemostatics on the long-term survival and recurrence of patients with early stage hepatocellular carcinoma（HCC）following curative resection.Methods A total of 504 patients undergoing hepatectomy during 2005-2007 in our hospital were included in this study.The HCC tumors had a diameter less than 5cm,at T1-2N0M0,and with pathological negative margins.The liver function of patients was Child-Pugh score A,B grade.Cox model with stepwise regression analysis was used to analyze the factors related to survival of patients and recurrence after surgery,and Kaplan-Meier analysis was used to clarify whether intravenous hemostatic agent is related to the overall survival time（OS）and recurrence-free survival time（RFS）.Results The median follow-up time for the patients was 64 months（7-72 months）.Perioperative intravenous hemostatic agents were used in 326 of the 504 patients and the rest did not receive any hemostatic agents during the perioperative period.The 5-year OS rate of patients receiving hemostatic agents was significantly lower than those receiving no hemostatic agents（61.04% vs 75.28%,P=0.002）,and the same was also true for the 5-year RFS rate in the two groups（49.08% vs 61.80%,P=0.001）.Cox model with stepwise regression analysis showed that perioperative use of intravenous hemostatic agents was an independent risk factor of patients＇ OS（P=0.001,relative risk 1.872,95% CI 1.298-2.702）and RFS（P=0.005,relative risk 1.523,95% CI 1.136-2.043）.Conclusion Application of intravenous hemostatic agents during perioperative period might be associated with poor overall andrecurrence-free survival of patients with early stage HCC after curative resection.

关 键 词：肝肿瘤 肝细胞癌 肝切除术 静脉止血药 存活率分析 

分 类 号：R735.7[医药卫生—肿瘤]