高龄肝癌患者肝癌切除术后并发症及预后分析  

Analysis of Complications and Outcomes after Hepatic Resection in Aged Patients

作　　者：陈安[1] 杨振宇[1] 殷祥烨 刘尧[2] 杜锡林[1] 

机构地区：[1]第四军医大学附属唐都医院普通外科,陕西西安710038 [2]第四军医大学学员旅,陕西西安710038

出　　处：《现代生物医学进展》2016年第28期5464-5467,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81172287)

摘　　要：目的:探讨高龄原发性肝癌患者肝癌根治性切除术的疗效及安全性。方法:回顾性分析63例(高龄组≥70岁)与98例(对照组<70岁)行肝部分切除术的原发性肝癌患者的一般资料及其围手术期情况,对其术后并发症及预后进行探讨。结果:高龄组术后并发症发生率为36.5%,对照组31.6%(P>0.05),高龄组7(11.1%)例肝衰竭,2(3.17%)例术后有出血现象,3(4.8%)例切口感染,3(4.8%)例胸腔积液,1(1.5%)例伴有隔下感染,1(1.5%)例有严重肺部感染,由于下肢深静脉血栓脱落,死于急性肺动脉栓塞。组织病理类型高龄组以结节型多见,Edmondson Ⅰ-Ⅱ级33例,Ⅲ-Ⅳ级18例,胆管细胞癌8例,混合细胞型4例。BCLC-0、A、B、C期分别占2、9、35、17例。高龄组与对照组1、2、3年生存率分别为82.5%VS85.7%、34.9%VS46.3%、15.9%VS36.8%。结论:高龄对肝部分切除术后并发症的发生并无明显影响,并不是原发性肝癌根治性手术切除术的禁忌症,高龄患者2、3年生存率较对照组低。Objective： To explore the therapeutic effect and degree of safety in aged patients with primary carcinoma of the liver undergoing radical resection. Methods： The clinical records of 63 patients （older group〉 70years） and 98 patients （younger group〈70 years） with PLC undergoing resection surgery analyzed retrospectively, and the follow-up of these patients was performed, we investigated and discussed the postoperative complications and？the clinical features or prognoses of these people. Results： The post-operative complications （POC） occurred in 23 of older group（36.5%） versus 31 in younger group（31.6%）（P〉0.05）, POC occurred in older group of 7 （11.1%） cases of liver failure, 2 （3.17%） cases of postoperative bleeding, 3 （4.8%） cases incision infection, 3（4.8%） cases ofpleural effusion, 1 （1.5%） cases ofsub-phrenic infection, 1 （1.5%）case with severe pulmonary infection. Only one patient died to the acute pulmonary embolism. The histopathology diagnosis showed there were nodes and giant mass type in aged patients, and Edmondson Ⅰ-Ⅱ in 33 patients, Ⅲ-Ⅳ in 18, cholangiocarcinoma in 8, Mixed cellularity in 4. The cases ofBCLC 0, A, B, C phase respectively has 2, 9, 35, 17. The survival rate of older group verses younger group was 82.5%vs85.7%, 34.9%vs46.3%/15.9%vs36.8% at 1, 2 and 3 years, respectively. Conclusion： Advanced age has no obvious effect on the occurrence of POC after hepatectomy and is not a contraindication to radical hepatic resection in patients over 70 years old suffering from early primary liver carcinoma, however, older group patients has lower survival rate than younger group patients in 2 and 3 year.

关 键 词：高龄 原发性肝癌 肝切除术 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]