60例肝细胞癌进行肝切除手术的长期随访预后因素分析  

Risk Factors Analysis of Prognosis of Patients with Hepatocellular Carcinoma after Hepatectomy:report of 60 cases

作　　者：梁玉宏 江友[2] 

机构地区：[1]深圳市龙华新区中心医院社康科,518110 [2]深圳市宝安区石岩人民医院普外科,518018

出　　处：《中华普外科手术学杂志（电子版）》2017年第3期214-217,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：深圳市宝安区科技创新局(2012117)

摘　　要：目的分析肝细胞癌患者进行肝切除手术后影响预后的相关因素。方法回顾性分析2008年1月至2013年4月间收治的60例行肝切除手术治疗的肝细胞癌患者资料,应用SPSS 17.0软件进行统计学处理分析,以性别、年龄、HBs Ag阳性率、HCV阳性率、有无肝硬化、术前AFP、肿瘤最大径、TNM分期、有无肿瘤包膜、是否侵及肝被膜、有无脉管瘤栓、肿瘤切缘、有无卫星灶形成等指标为自变量,以3年生存率为因变量,采用χ2检验方法进行单因素分析,分析后得出有统计学意义的相关变量,逐步依次引入Cox比例风险模型进行多因素分析,P<0.05表示差异有统计学意义。结果随访3年后,60例患者存活28例,生存率为46.7%。单因素分析结果显示,患者肝硬化、术前AST水平、肿瘤最大径>5 cm、侵及肝被膜、脉管瘤栓、肿瘤切缘≤1 cm、卫星灶形成是肝癌患者行肝切除手术预后的影响因素(P<0.05)。多因素分析结果显示,肿瘤最大径>5 cm、侵及肝被膜、脉管瘤栓、肿瘤切缘≤1 cm、卫星灶形成均为影响肝癌患者肝切除术后预后的危险因素(P<0.05)。结论肝癌患者行肝切除手术的预后与多种因素相关,脉管瘤栓、肿瘤切缘≤1 cm、卫星灶形成是主要危险因素,加强术后针对性的辅助治疗是改善疗效、提高远期生存的关键。Objective To analyze the risk factors of prognosis of patients with hepatocellular carcinoma after hepatectonly. Methods From January 2008 to April 2013, the clinical data of 60 patients with hepatocellular carcinoma were retrospectively analyzed by using SPSS17.0 software. Clinical data such as gender, age, positive rate of HBsAg, positive rate of HCV, cirrhosis （absent/present）, preoperative AFP, maximum tumor diameter, TNM stage, capsule （absent/present） , whether invaded the liver capsule, invading blood vessels or liver capsule, tumor resection margin and satellite opacities formation were collated as independent variables, while the 3 years survival rate as dependent variable,. The univariate analysis was conducted by using X^2 test method, then multivariate analysis was performed by using Cox proportional hazard model. A P value 〈 0.05 was considered as statistically significant difference. Results After the 3 years-follow-up, 28 patients （46. 7% ） survived. Results of univariate analysis showed that cirrhosis, preoperative AST level, maximum tumor diameter 〉 5 cm, liver capsule invasion, vascular tumor thrombus, tumor resection margin ≤ 1 cm, satellite opacities formation were influencing factors of prognosis （P 〈0.05）. Conclusion The prognosis of patients with hepatoeeflular carcinoma after hepatectomy is affected by multiple factors mainly including vascular tumor thrombus, tumor resection margin ≤1cm and satellite opacities formation. It is the key to improve the curative effect and to improve long-term survival to strengthen the targeted adjuvant therapy.

关 键 词：癌 肝细胞 肝切除术 随访研究 预后 因素分析 统计学 

分 类 号：R735.7[医药卫生—肿瘤]