手术与介入在原发多灶性肝癌治疗中疗效的比较分析  

Comparative Analysis of the Efficacy of Surgery and Intervention in the Treatment of Primary Multiple Liver Cancer

作　　者：李浩[1] 江谋应 许朱定 LI Hao;JIANG Mou-ying;XU Zhu-ding(Department of General Surgery,Anqing First People’s Hospital,Anqing(246004),China)

机构地区：[1]安庆市第一人民医院普外科,安庆246003 [2]安庆市第一人民医院放射科,安庆246003 [3]上海市东方肝胆医院肝科五科,上海200438

出　　处：《中国中西医结合外科杂志》2020年第3期524-530,共7页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:比较手术治疗与介入治疗对原发多灶性肝癌患者的治疗效果。方法:回顾分析安庆市第一人民医院普外科、介入科和上海东方肝胆外科医院肝外五科2012年1月-2016年12月收治的139例原发多灶性肝癌首诊患者(安庆市第一人民医院69例,上海东方肝胆外科医院70例)。采用Cox比例风险模型进行预后相关文献因素的回归分析。结果:本组139例患者中手术治疗组患者68例(安庆市第一人民医院31例,上海东方肝胆外科医院37例),介入治疗组患者71例(安庆市第一人民医院36例,上海东方肝胆外科医院35例)。手术治疗组患者的1年、3年和5年生存率分别为92.6%、45.4%、20.8%,中位生存时间为34(95%CI:29~44)个月。介入治疗组患者的1年、3年和5年生存率分别为77.5%、16.5%、2.4%,中位生存时间为19(95%CI:15~23)个月。手术治疗组患者的总体生存时间明显长于介入治疗组(HR=2.27,95%CI:1.55~3.31,P<0.001)。相比介入治疗,手术治疗能显著延长Ib期及IIa期患者的总体生存时间,但手术治疗未能使IIb期患者显著获益。多因素回归分析显示,影响患者总体生存时间的独立危险因素包括甲胎蛋白水平≥400 ng/mL、肿瘤数目≥4个、超出米兰标准和肿瘤治疗方法。结论:对于肿瘤数目在3个以内的肝癌患者,手术治疗疗效优于介入治疗。Objective Patients with primary multiple hepatocellular carcinomas(HCCs)often has a poor prognosis,the surgical indications for primary multiple HCCs remain controversial.The aim of the study is to evaluate the survival benefits of liver resection compared with trans-arterial chemoembolization(TACE)for patients with multiple hepatocellular carcinomas(HCCs).Methods A retrospective analysis was conducted on 139 patients with multiple liver cancer admitted to the department of general surgery of Anqing first people’s hospital,department of interventional medicine of Anqing first people’s hospital and the fifth department of hepatobiliary surgery of Shanghai Easternl hepatobiliary surgery hospital from January 2012 to December 2016(69 cases in Anqing first people's hospital and 70 cases in Shanghai Easternl hepatobiliary surgery hospital).Cox proportional risk model was used for regression analysis of prognostic literature factors.Results In this study,a total of 68 patients were included in the surgical treatment group(31 cases in Anqing first people’s hospital and 37 cases in Shanghai Easternl hepatobiliary surgery hospital)and 71 patients were in the interventional treatment group(36 cases in Anqing first people’s hospital and 35 cases in Shanghai Easternl hepatobiliary surgery hospital).The 1-year,3-year,and 5-year survival rates in the surgical group were 92.6%,45.4%and 20.8%respectively,with a median survival of 34 months(95%CI:29-44 months).The 1-year,3-year,and 5-year survival rates in the interventional treatment group were 77.5%,16.5%,and 2.4%respectively,with a median survival of 19 months(95%CI:15-23 months).Overall survival was significantly longer in the surgical group than that in the interventional group(HR 2.27,95%CI:1.55-3.31,P<0.001).Compared with interventional therapy,surgical treatment can significantly prolong the overall survival time of patients in stage Ib and IIa,but surgical treatment does not significantly benefit patients in stage IIb.Multivariate regression analysis showed that

关 键 词：手术治疗 介入治疗 多灶肝癌 疗效 对比 

分 类 号：R735.7[医药卫生—肿瘤]