宽切缘根治切除治疗伴微血管侵犯的原发性肝癌患者预后及原发性肝癌手术患者短期预后影响因素分析  

Analysis of Prognosis and Influencing Factors of Short-term Prognosis in Patients with Primary Liver Cancer and Microvascular Invasion Treated by Resection with Wide Margin

作　　者：孔德帅[1] 袁俊建[1] 陈雄飞[1] 张雷[1] 赵秀雷[1] 李凤山[1] 刘汝海[1] KONG De-shuai;YUAN Jun-jian;CHEN Xiong-fei;ZHANG Lei;ZHAO Xiu-lei;LI Feng-shan;LIU Ru-hai(Department of General Surgery,the Central Hospital of Cangzhou,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州市中心医院普外科

出　　处：《临床误诊误治》2019年第7期85-88,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划项目(20191256)

摘　　要：目的分析宽切缘根治切除治疗伴微血管侵犯(microvascular invation,MVI)的原发性肝癌患者预后及原发性肝癌手术患者短期预后的影响因素。方法选取2012年1月—2015年12月我院收治的345例原发性肝癌患者作为研究对象,对其临床及随访资料进行回顾性分析,比较MVI阳性组和MVI阴性组采用宽切缘与窄切缘手术治疗后3年的复发率及生存率;比较宽切缘组(切缘≥1cm)和窄切缘组(切缘<1cm)患者术后并发症发生情况;分析影响原发性肝癌手术患者短期预后的因素。结果MVI阳性组采用宽切缘手术切除患者较窄切缘手术切除患者,术后3年复发率明显降低,3年生存率明显升高,差异均有统计学意义(P<0.01);MVI阴性组不同手术切缘患者术后3年复发率及生存率比较差异均无统计学意义(P>0.05)。宽切缘组和窄切缘组术后总并发症发生率比较差异无统计学意义(P>0.05)。非条件多因素logistic回归分析显示,窄切缘、肿瘤直径>5cm、MVI阳性、肿瘤包膜不完整及血清甲胎蛋白水平过高为原发性肝癌手术患者短期预后的独立危险因素。结论宽切缘根治切除治疗伴MVI的原发性肝癌患者预后较好,且具有一定的安全性;窄切缘、肿瘤直径>5cm、MVI阳性、肿瘤包膜不完整及血清甲胎蛋白水平过高为原发性肝癌手术患者短期预后的独立危险因素。Objective To analyze the prognosis and influencing factors of short-term prognosis in patients with primary liver cancer and microvascular invasion (MVI) treated by resection with wide margin. Methods A total of 345 patients with primary liver cancer admitted to our hospital from January 2012 to December 2015 were selected as subjects. The clinical and follow-up data were retrospectively analyzed. Moreover, 3-year survival and recurrence rate in MVI positive group and MVI negative group were compared between patients with liver cancer who underwent resection with wide margin and those with narrow margin. The postoperative complications of patients in wide margin group (cut margin ≥1 cm) and narrow margin group (cut margin <1 cm) were analyzed. The factors affecting the short-term prognosis of patients with primary liver cancer were analyzed. Results For MVI positive patients with liver cancer, compared with patients with wide margin, those with narrow margin had a significantly lower 3-year recurrence rate and a significantly higher 3-year survival rate ( P <0.05). For MVI negative patients with liver cancer, there was no difference in 3-year recurrence rate and survival rate ( P >0.05).There was no significant difference in the incidence of complications between the wide margin and the narrow margin groups ( P >0.05). Non-conditional multivariate logistic regression model showed that resection with narrow margins, diameter of tumor>5 cm, MVI positive, incompleteness of tumor capsule and excessively high levels of serum alpha-fetoprotein were independent risk factors affecting the short-term prognosis of patients with primary liver cancer. Conclusion Resection with wide margin for the treatment of MVI patients with primary liver cancer has a better prognosis and a certain degree of safety. Narrow margin, diameter of tumor >5 cm, MVI positive, incompleteness of tumor capsule and high levels of serum alpha-fetoprotein are independent risk factors for short-term prognosis in patients with primary liver cancer.

关 键 词：肝肿瘤 宽切缘 微血管侵犯 预后 

分 类 号：R735.7[医药卫生—肿瘤]