肝细胞癌切除术后复发再次手术切除的疗效分析  

Repeat hepatectomy for post-hepatectomy recurrent hepatocellular carcinoma

作　　者：焦守斐 李冠群[1] 张东欣 许英晨[1] 刘杰[1] 夏峰[1] 张立军[1] 付建柱[1] 计嘉军[1] 栗光明 Jiao Shoufei;Li Guanqun;Zhang Dongxin;Xu Yingchen;Liu Jie;Xia Feng;Zhang Lijun;Fu Jianzhu;Ji Jiajun;Li Guangming(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Center of General Surgery,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京同仁医院普外科,北京100730 [2]首都医科大学附属北京佑安医院普通外科中心,北京100069

出　　处：《中华肝胆外科杂志》2020年第5期335-338,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：首都医科大学附属北京同仁医院种子基金(2018-YJJ-ZZL-014)。

摘　　要：目的研究肝细胞癌切除术后复发患者再次手术切除的疗效。方法回顾性分析2013年5月至2016年5月北京同仁医院普外科收治的肝细胞癌切除术后复发并再次行手术切除的患者资料(复发组),以及同一时期北京同仁医院普外科收治的肝细胞癌首次行手术切除的患者资料(原发组),比较两组患者之间一般资料、围手术期资料、术后并发症及生存期。结果原发组纳入179例患者,其中男性133例,女性46例,年龄14.0~84.0(57.3±11.7)岁;复发组纳入36例患者,其中男性30例,女性6例,年龄40.0~77.0(55.9±11.4)岁。两组患者之间性别、年龄、肝炎病毒感染状态、术前甲胎蛋白、Child-Pugh评分及吲哚菁绿排泄试验15 min滞留率的差异均无统计学意义(P>0.05);两组在手术时间[(244.2±84.3)min比(283.4±66.8)min]、术中出血量[(428.5±151.6)ml比(756.2±187.4)ml]、是否为解剖性肝切除、是否单发肿瘤及肿瘤最大直径[(5.81±2.24)cm比(3.69±1.55)cm]方面的差异具有统计学意义(P<0.05);两组在是否侵犯包膜、有无脉管内癌栓及肿瘤分化程度方面的差异无统计学意义(P>0.05);两组手术并发症之间的差异无统计学意义(P>0.05);两组患者1年、3年总生存率及无瘤生存率之间的差异无统计学意义(P>0.05)。结论肝细胞癌切除术后复发患者再次手术切除与首次手术切除的疗效无显著差别,是安全有效的治疗方法。Objective To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min (P>0.05). However, there were statistically significant differences (P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation (P>0.05). There were no statistically significant differences in surgical complication rates (P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups (P>0.05).Conclusions Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.

关 键 词：癌 肝细胞 复发 再次肝切除 预后 

分 类 号：R735.7[医药卫生—肿瘤]