布加综合征合并肝细胞癌的临床特点及预后  

Clinicopathological features and prognosis of Budd-Chiari syndrome associated with hepatocellular carcinoma

作　　者：吴康[1] 许伟[1] 祖茂衡[1] 徐浩[1] 顾玉明[1] 张庆桥[1] 魏宁[1] 崔艳峰[1] 

机构地区：[1]徐州医学院附属医院介入放射科,221006

出　　处：《中华肝胆外科杂志》2016年第3期159-163,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：江苏省科技创新与成果转化专项基金资助项目（BL2012021）

摘　　要：目的探讨布加综合征（BCS）合并肝细胞癌（HCC）的临床特点及预后。方法回顾性分析33例BCS合并HCC患者的临床资料。33例患者均行下腔静脉成形术序贯肝癌切除治疗，其中16例术后行预防性肝动脉化疗栓塞（TACE）。选择同期于我院行肝癌切除术的乙型肝炎病毒（HBV）合并HCC患者110例作为对照，其中52例术后行预防性TACE。对两组患者的临床病理特征、手术情况、无瘤生存期和总体生存期进行分析对比。结果BCS合并HCC组患者的性别、年龄分布以及肝功能Child．Pugh分级、甲胎蛋白、肿瘤大小与HBV合并HCC组差异无统计学意义（P〉0．05）。BCS合并HCC组肿瘤单发率、边缘及外生型生长率和高分化率高于HBV合并HCC组，而门静脉侵袭率则低于HBV合并HCC组，差异均有统计学意义（P〈0．05）。BCS合并HCC组患者有较少的术中出血量[（432．3±125．8）m1比（565．2±143．2）ml，P〈0．05]、较短的手术时间[（132．8±25．5）min比（173．7±32．3）min，P〈0．05]及较短血流阻断时间[（15．3±3．6）rain比（21．9±7．4）min，P〈0．05]。BCS合并HCC患者1、3、5年总体生存率分别为93．1％、74．1％、55．2％，HBV合并HCC患者为82．6％、45．9％、17．3％；BCS合并HCC患者1、3、5年无瘤生存率分别为86．2％、51．7％、0，HBV合并HCC患者为57．1％、10．2％、0。两组总体生存率、无瘤生存率比较差异显著（P均〈0．05）。结论BCS合并的HCC较HBV合并的HCC恶性程度低，预后好，下腔静脉成形术序贯肝癌切除治疗BCS合并HCC安全、有效。Objective To analyze the clinicopathological features and prognosis of Budd-Chiari syn- drome （BCS） associated with hepatocellular carcinoma （HCC）. Methods The clinical data of 33 patients with HCC complicated by BCS were retrospectively analyzed. All the patients underwent sequential percuta- neous transluminal angioplasty to relief the obstruction of the inferior vena cava and then hepatic resection for HCC. There were 16 of these patients （48.5%） who underwent postoperative adjuvant TACE. For compari- son, 110 patients with HBsAg ± HCC were randomly selected, and 52 of these patients （47.3%） underwent postoperative adjuvant TACE. The clinicopathological, operative outcomes, disease-free survival and overall survival rates between these 2 groups of patients were compared. Result There were no significant differ- ences in gender, age, Child Pugh, AFP and tumor size. However, patients with BCS-associated HCC had significantly higher incidences of solitary tumors, marginal or exogenous growths, poor degrees of tumour dif- ferentiation but a lower rate of portal vein invasion. They also had significantly less intraoperative blood loss [ （432. 3 ± 125.8 ） ml vs （ 565.2 ± 143.2 ） ml, P 〈 0. 051, shorter operation time [ （ 132. 8 ± 25.5 ） min vs （ 173.7 ± 32. 3 ） min, P 〈 0.05 ] and shorter vascular clamping time [ （ 15.3 ± 3.6 ） min vs （ 21.9 ± 7.4 ） mln, P 〈0. 05 ] when compared with patients with HBV associated HCC. The 1-, 3-, 5-year overall survival rates were 93.1%, 74. 1%, 55.2% , respectively, for patients with BCS-associated HCC and 82. 6%, 45.9%, 17.3% , respectively, for patients with HBV-associated HCC. The corresponding 1-, 3-, 5-year disease-free survival rates were 86. 2%, 51.7%, 0, respectively, versus 57. 1%, 10. 2%, 0, respectively. The differences in overall and disease-free survival rates between the two groups were significant （P 〈0. 05 ）. Conclusions BCS-associated HCC had more favorable biological behavior and prognosis than HBV- associa

关 键 词：布加综合征 肝细胞癌 血管成形术 肝切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤]