再次肝切除治疗复发性肝癌疗效及预后因素分析  

Repeated hepatectomy for recurrent liver cancer: efficacy and prognostic factors

作　　者：许继凡 戴珏[2] 郭涛[2] 皮亮[2] 刘钊[2] 罗诗樵[2] 

机构地区：[1]重庆市开县人民医院肝胆外科,重庆405400 [2]重庆医科大学附属第一医院肝胆外科,重庆404100

出　　处：《中国普通外科杂志》2014年第7期873-877,共5页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(30972789)

摘　　要：目的：探讨再次肝切除治疗复发性肝癌的价值并分析影响预后的相关因素。方法：回顾性分析重庆医科大学附属第一医院2006—2013年26例复发性肝癌施行再次肝切除的临床资料。结果：首次与再次手术的术中出血量、手术时间差异无统计学意义（均P〉0.05）。首次术后中位无瘤生存时间21.0（3~192）个月,1、3、5年无瘤生存率为69.6%、26.1%、8.7%;再次肝切除术后中位无瘤生存时间为19.0（3~35）个月,1、3、5年无瘤生存率为68.4%、0、0,中位生存时间为40.0个月,1、3、5年累积生存率为83.5%、55.7%、13.0%。26例患者总的生存时间为（87.8±19.3）个月,总中位生存时间为57.0个月,1、3、5年累计生存率100%、60.8%、30.4%。首次术后早期（2年内）复发行再次肝切除患者的生存率明显低于首次术后晚期（2年后）复发行再次切肝除患者（P=0.001）。单因素分析显示,复发间隔、手术方式及病理分期与再次肝切除术后的生存有关（均P〈0.05）,三者在多因素分析中的P值分别为0.089、0.006、0.054。结论：再次肝切除可提高复发性肝癌总生存率,但要严格选择适应证与合理的手术方式。复发间隔越短及肿瘤病理分期越晚,再次肝切除手术预后不良。Objective： To assess the value of repeated hepatectomy for recurrent hepatocellular carcinoma （HCC） and analyze the associated factors affecting the prognosis. Methods： The clinical data of 26 patients undergoing repeated hepatectomy for recurrent HCC in the First Affiliated Hospital of Chongqing Medical University, between 2006 and 2013 were retrospectively analyzed. Results： The intraoperative blood loss and operative time between the first operation and second operation had no statistical difference （both P＆gt;0.05）. For the first operation, the postoperative median tumor-free survival time was 21.0 （3-192） months and the postoperative 1-, 3- and 5-year tumor-free survival rate was 69.6%, 26.1% and 8.7%, respectively; for the second operation, the postoperative tumor-free survival time was 19.0 （3-35） months, the postoperative 1-, 3- and 5-year tumor-free survival rate was 68.4%, 0% and 0%, the postoperative median survival time was 40.0 months, and the postoperative 1-, 3- and 5-year accumulative survival rate was 83.5%, 55.7% and 13.0%, respectively. Of the 26 patients, the overall survival time was （87.8±19.3） months, overall median survival tine was 57.0 months, and the 1-, 3- and 5-year accumulative survival rate was 100%, 60.8% and 30.4%, respectively. The survival rate in patients undergoing second liver resection for early recurrence after first operation （within 2 years） was significantly lower than those undergoing second liver resection for late recurrence after first operation （more than 2 year later） （P=0.001）. Univariate analysis showed that recurrence interval, surgical type, and pathological stage were associated with the postoperative survival of repeated hepatectomy, and the P value for the three factors in multivariate analysis was 0.089, 0.006 and 0.054, respectively. Conclusion： Repeated hepatectomy can improve the overall survival rate of recurrent HCC patients, but the indications and rational surgical type should be strictly chosen. Those with

关 键 词：肝肿瘤 肝切除术 复发 再手术 预后 

分 类 号：R735.7[医药卫生—肿瘤]