符合米兰标准的中央型肝癌手术切除疗效分析  

Analysis of clinical efficacy of surgical resection of central hepatocellular carcinoma conforming to Milan criteria

作　　者：吴若林[1] 方翊天 赵红川[1] 黄帆[1] 王国斌[1] 余孝俊[1] 侯刘进 耿小平[1] 叶征辉 张兴华 Wu Ruolin;Fang Yitian;Zhao Hongchuan;Huang Fan;Wang Guobin;Yu Xiaojun;Hou Liujin;Geng Xiaoping;Ye Zhenghui;Zhang Xinghua(Organ Transplantation Center,DepartmentⅡof Hepatobiliopancreatic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院器官移植中心,肝胆胰二病区,合肥230022

出　　处：《中华肝脏外科手术学电子杂志》2020年第2期142-147,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：安徽医科大学第一附属医院院内青年基金(2019kj12)。

摘　　要：目的探讨符合米兰标准的中央型肝细胞癌(肝癌)外科手术切除的疗效。方法回顾性分析2010年1月至2015年6月在安徽医科大学第一附属医院行肝切除术的76例肝癌患者临床资料。其中男62例,女14例;平均年龄(57±11)岁。患者均签署知情同意书,符合医学伦理学规定。根据肿瘤位置分为中央型组(22例)和周围型组(54例)。分析比较两组患者术中、术后情况及生存情况。两组肿瘤复发率的比较采用χ^2检验。采用Kaplan-Meier法绘制生存曲线,生存分析采用Logrank检验。结果中央型组患者肿瘤复发率为59%(13/22),其中肝内复发11例,肺部转移1例,脑转移1例;周围型组肿瘤复发率为46%(25/54),其中肝内复发22例,肺部转移2例,纵膈转移1例,骨转移1例;两组肿瘤复发率比较差异无统计学意义(χ^2=1.024,P>0.05)。中央型组患者术后1、3、5年无瘤生存率分别为68.2%、45.5%、40.9%,周围型组相应为79.5%、67.8%、56.9%,两组无瘤生存率差异无统计学意义(χ^2=2.242,P>0.05)。中央型组术后1、3、5年总体生存率分别为86.4%、68.2%、50.9%,周围型组相应为96.3%、83.3%、71.6%,两组总体生存率差异无统计学意义(χ^2=1.276,P>0.05)。结论符合米兰标准的中央型肝癌接受肝切除术能取得与周围型肝癌相当的远期生存疗效。Objective To evaluate the clinical efficacy of surgical resection of central hepatocellular carcinoma(HCC)conforming to the Milan criteria.Methods Clinical data of 76 HCC patients who underwent hepatectomy in the First Affiliated Hospital of Anhui Medical University from January 2010 to June 2015 were retrospectively analyzed.Among them,62 patients were male and 14 female,aged(57±11)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.According to the tumor location,all patients were divided into central type group(n=22)and peripheral type group(n=54).Intraoperative and postoperative conditions and survival were statistically compared between two groups.The recurrence rate between two groups was statistically compared by Chi-square test.The survival curve was delineated by Kaplan-Meier method.Survival analysis was performed by Log-rank test.Results The recurrence rate in central type group was 59%(13/22),including 11 cases of intrahepatic recurrence,1 case of lung metastasis and 1 case of brain metastasis.The recurrence rate in peripheral type group was 46%(25/54),including 22 cases of intrahepatic recurrence,2 cases of lung metastasis,1 case of mediastinal metastasis and 1 case of bone metastasis.No significant difference was observed between two groups in tumor recurrence rate(χ^2=1.024,P>0.05).The 1-,3-,and 5-year disease-free survival rates in central type group were 68.2%,45.5%,and 40.9%,which did not significantly differ from 79.5%,67.8%,and 56.9%in peripheral type group(χ^2=2.242,P>0.05).The 1-,3-,and 5-year overall survival rates in central type group were 86.4%,68.2%,and 50.9%,which did not significantly differ from 96.3%,83.3%,and 71.6%in peripheral type group(χ^2=1.276,P>0.05).Conclusions Patients with central HCC conforming to the Milan criteria can obtain similar long-term survival as the patients with peripheral HCC.

关 键 词：癌 肝细胞 米兰标准 肝切除术 肿瘤转移 

分 类 号：R735.7[医药卫生—肿瘤]