急诊与延期肝切除对可切除性肝癌破裂出血患者腹腔转移的影响  

Role of emergency and staged hepatectomy in peritoneal metastasis associated with spontaneous rupture of resectable hepatocellular carcinoma patients

作　　者：杨先模 闫挺[1] 任翱[1] 耿波[1] 李泽朝 罗诗樵[1] 

机构地区：[1]重庆医科大学附属第一医院肝胆外科,400016

出　　处：《中华肝胆外科杂志》2017年第4期225-229,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（30972789）;重庆市自然科学基金（cstc2013jcyjA10105）

摘　　要：目的评价急诊与延期肝切除治疗可切除性原发性肝细胞癌（HCC）破裂出血的疗效，分析手术时机对肝癌术后腹腔转移的影响。方法回顾性分析我院2011年8月至2016年1月收治的38例HCC破裂出血且行肝切除患者的临床资料。将入院后24小时内手术者归为急诊组，1周后手术者归为延期组，比较两组患者围手术期情况、术后生存率、无瘤生存率及复发转移率。结果急诊组术中出血量及输血量均多于延期组（均P〈0．05），住院期间死亡率差异无统计学意义（6．0％比0％，P〉0．05）。急诊组与延期组患者术后中位生存期分别为22．5个月和14．2个月。急诊组术后半年、1年、3年的总体生存率分别为88．2％、82．4％和30．3％，无瘤生存率分别为81．3％、54．7％和27．3％，1年生存率及半年无瘤生存率均高于延期组（均P〈0．05）。延期组术后腹腔转移率高于急诊组，但差异无统计学意义（38．1％比29．4％，P〉0．05）。单因素及多因素分析显示肿瘤直径≥10cm及AFP〉10000μg／L为肝癌破裂出血患者发生腹腔转移的危险因素。结论急诊肝切除术后患者短期预后优于延期组。延期肝切除不增加肝癌破裂出血患者腹腔种植转移的发生率。肿瘤直径≥10cm和AFP〉10000μg／L是肝癌破裂出血患者发生腹腔种植转移的危险因素。Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma （HCC） patients, and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients. Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016. These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission, and staged group who underwent the procedure one week after admission. Perioperative events, overall survival （OS） and disease-free- survival （DFS） rates, incidence of recurrent and metastatic disease were compared between the two groups. Results The perioperative blood loss and transfusion were much more in emergency group than staged group （both P 〈 0. 05 ）. Nevertheless, the incidence of postoperative mortality was not significantly different （6. 0% vs 0%, P 〉 0. 05 ）. The median survival was 22.5 months in emergency group versus 14.2 months in staged group. The 6-month, 1-year, 3-year OS rates in emergency group were 88.2%, 82.4% and 30. 3% respectively, and 6-month, 1-year, 3-year DFS rates were 81.3%, 54.7% and 27.3%. The 1-year OS and 6-month DFS rates were higher than those of staged group （ both P 〈 0.05）. The incidence of peritoneal metastasis in staged group was higher than that in emergency group, but it was not significantly different （ 38.1% vs 29.4% , P 〉 0.05 ）. Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP 〉 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage. Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage. Staged hepatectomy would not raise the po

关 键 词：原发性肝癌 自发性破裂 肝切除术 腹腔转移 

分 类 号：R735.7[医药卫生—肿瘤]