手术时机的选择对原发性肝癌破裂出血术后预后生存的影响  

Effect of timing of surgery on the prognosis of patients with primary liver cancer after operation

作　　者：钱相君 贺涛[1] 万百顺[1] 王效谦 张玲[1] 

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)肝胆胰腺外科,河南郑州450008

出　　处：《胃肠病学和肝病学杂志》2017年第4期407-411,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的研究手术时机的选择对原发性肝癌(primary liver cancer,PLC)破裂出血术后预后生存的影响及大网膜切除联合腹腔热灌注预防腹腔转移的临床疗效。方法回顾性分析河南省肿瘤医院2011年1月-2016年6月收治的行手术治疗的PLC破裂出血患者52例;手术切除肿瘤的同时行大网膜切除术,术后1 d行腹腔热灌注治疗;并依据PLC破裂出血发病至手术的间隔时间,将患者分为早期(≤2周)手术组21例和延期(>2周)手术组31例,比较两组患者的腹腔转移及生存预后。结果早期组与延期组术后无病生存时间的差异有统计学意义(P<0.05);总生存时间的差异无统计学意义(P>0.05),但早期组仍优于延期组。术后总的腹腔内种植转移发生率仅为4.2%(2/48),早期组腹腔转移率(0)低于延期组(7.1%)。结论 PLC破裂出血发病至手术间隔时间是影响患者术后无病生存期的显著因素,对腹腔转移、长期生存也有一定影响;肝肿瘤切除同时行大网膜切除联合腹腔热灌注能有效降低PLC破裂术后腹腔种植转移率。Objective To investigate the effect of timing of surgery on the prognosis of patients with primary liver cancer （PLC） after operation and the clinical effect of greater omentum resection combined with hyperthermic intraperitoneal perfusion preventing intraperitoneal metastasis. Methods Fifty-two cases treated by operations from Jan. 2011 to Jun. 2016 were retrospectively analyzed. The tumor and greater omentum were surgically removed simultaneously and the hyperthermic intraperitoneal perfusion were applied one day after the surgery for all the patients. According to the in- terval between paroxysm after PLC rupture and operation, the patients were divided into early operation group （ 〈 2 weeks） 21 cases and delayed operation group （ 〉 2 weeks） 31 cases. Then the intraperitoneal metastasis and survival prognosis between two groups were compared. Results There was significant statistical difference in the disease free sur- vival between two groups （P 〈 0.05）. There was no significant difference in overall survival between two groups （P 〉 0.05）, the early group still had advantages over the delayed group. The total intraperitoneal metastasis rate was only 4.2% （2/48） after opertation, and the rate of the early group （0） was lower than that of the delayed group （7.1%）. Conclusion The incidence of rupture of PLC to the time of operation is a significant factor affecting the survival time of patients after operation, it also has a certain effect on the intraperitoneal metastasis and long-term survival. The greater omentum resection combined with hyperthermic intraperitoneal perfusion after hepatectomy can effectively reduce the in- cidence of intraperitoneal implantation metastasis of the patients with PLC rupture and hemorrhage.

关 键 词：原发性肝癌 破裂出血 手术时机 大网膜 腹腔热灌注 腹腔种植转移 

分 类 号：R735.7[医药卫生—肿瘤]