影响肝癌合并门脉高压症患者行R0切除的疗效、安全性及预后的因素分析  

Analysis of the factors affecting the efficacy,safety and prognosis of R0 resection in hepatocellular carcinoma patients with portal hypertension

作　　者：陈晋[1] 王晓龙[1] 朱日祥[1] 

机构地区：[1]江苏省南通大学附属海安医院普外科,226600

出　　处：《临床外科杂志》2017年第3期182-185,共4页Journal of Clinical Surgery

摘　　要：目的探讨影响原发性肝细胞癌(hepatocellular carcinoma,HCC)合并门静脉高压症(portal hypertension,PH)患者行R0切除的疗效、安全性及预后的因素。方法肝硬化相关的HCC患者300例,均获获RO切除。根据患者术前是否伴有PH分为PH组和无PH组,比较两组患者的术后并发症和死亡率,采用Kaplan-Meier法分析影响患者R0切除术后生存的因素。采用Cox回归风险模型进行危险因素分析。结果 PH组和无PH组的手术死亡率分别为3.6%和0.5%,两组比较差异有统计学意义(P<0.05)。PH组术后并发症的发生率为22.6%,无PH组为9.7%,两组比较差异有统计学意义(P<0.05),尤其是肝病相关并发症(腹水>800 ml/d、肝功能不全和肝衰竭)的发生率。伴有PH(P<0.05)、甲胎蛋白≥20 ng/ml(P<0.05)、肿瘤直径>5 cm(P<0.05)、非孤立型HCC(P<0.05)、肝切除范围>1段(P<0.05)和术中输血(P<0.05)的患者其生存率明显降低。Cox回归分析显示,肿瘤直径>5 cm和非孤立型HCC是其独立危险因素。结论合并PH可增加HCC患者R0切除后的肝病相关并发症的发生率和手术死亡率,肿瘤直径>5cm和非孤立型HCC是影响患者长期生存的危险因素。Objective To investigate the factors affecting the efficacy, safety and prognosis of R0 resection in hepatocellular carcinoma（ HCC ） patients with portal hypertension （PH）. Methods Clinical data of 600 patients with cirrhosis related HCC undergoing hepatectomy at the Dept. of Hepatobiliary Surgery were studied retrospectively. According to whether the patients with portal hypertension or not, they were divided into PH group and non PH group. Postoperative complications and mortality were compared between the two groups. Kaplan-Meier was used to analyze influencing factors of patients with R0 postoperative survival. Cox regression risk model was used to analyze the risk factors. Results The operative mor- tality of PH group and non PH group was 3.6% （3/84） and 0.5% （ 1/216）, respectively. The differencewas statistically significant （ P 〈 0.05 ）. The incidence of postoperative complications in PH group was 22.6%, significantly higher than 9.7% in non PH group（P 〈 0.05 ）, especially the incidence rate of the liver related complications （ ascites 〉 800 ml/d, hepatic insufficiency and liver failure）. Alcoholism, with PH, AFP ≥ 20 ng/ml, tumor size 〉 5 cm and non-solitary type HCC （ all P 〈 0.05 ） were important factors for overall survival. Cox regression analysis showed that tumor size 〉 5 cm and non-solitary type HCC were independent predictors for survival. Conclusion PH combined with HCC patients after R0 resection can significantly increase the incidence of complications related to liver disease and mortality, tumor size 〉 5 cm and non -isolated HCC are the risk factors for long-term survival of patients.

关 键 词：原发性肝细胞癌 门静脉高压 肝切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤] R657.34[医药卫生—临床医学]