肝切除手术时机对肝癌破裂出血治疗效果的影响  

Effect of operation opportunity on therapeutic efficacy of hepatocellular carcinoma with rupture hemorrhage

作　　者：蔡重阳 胡深 赵金锋[1] 翟路路 王凯诚[1] Cai Chongyang;Hu Shen;Zhao Jinfeng;Zhai Lulu;Wang Kaicheng(Department of General Surgery,Hangzhou Hospital of Traditional Chinese Medicine,Zhejiang Hangzhou 310007,China;Second Affiliated Hospital of Zhejiang University,Zhejiang Hangzhou 310009,China;Department of General Surgery,Renmin Hospital of Wuhan University,Hubei Wuhan 430060,China)

机构地区：[1]杭州市中医院外一科,浙江杭州310007 [2]浙江大学附属第二医院,浙江杭州310009 [3]武汉大学人民医院普外科,湖北武汉430060

出　　处：《中国医刊》2020年第9期954-957,共4页Chinese Journal of Medicine

基　　金：浙江省基础公益研究项目(LGF19H290004)。

摘　　要：目的探讨肝切除手术时机对肝癌破裂出血患者临床治疗效果的影响。方法回顾性分析2013年6月至2016年2月浙江大学附属第二医院及杭州市中医院收治的72例肝癌破裂出血患者的临床资料,其中46例接受急诊肝切除术治疗(急诊手术组),26例经保守治疗待循环稳定、肝功能改善后接受延期肝切除术治疗(延期手术组)。记录两组患者的围术期指标,包括手术方式、术中出血量、术中输血量、手术时间、术后住院时间、首次进食时间、首次离床活动时间并进行组间比较。术后以门诊、电话形式进行随访,随访截止日期为2020年1月1日,比较两组患者的术后生存及复发情况。结果两组患者的手术方式、手术时间比较差异无显著性(P>0.05)。急诊手术组的术中出血量、术中输血量、首次进食时间和首次离床活动时间均高于延期手术组,而术后住院时间短于延期手术组,差异有显著性(P<0.05)。急诊手术组与延期手术组的中位无病生存时间分别为9.2个月和8.6个月,腹腔转移率分别为32.6%(15/46)和34.6%(9/26),差异均无显著性(P>0.05),但急诊手术组的复发转移率(43.5%)明显低于延期手术组(69.23%),差异有显著性(P<0.05)。急诊手术组术后1、2、3年总体生存率分别为84.8%、76.1%、45.7%,明显高于延期手术组的69.2%、57.7%、34.6%,差异有显著性(P<0.05)。急诊手术组的中位总生存时间为22.6个月,明显高于延期手术组的16.5个月,差异有显著性(P<0.05)。结论急诊行肝切除术治疗肝癌破裂出血虽然在短期内恢复较慢,但可获得更好的远期临床结局,降低复发转移率,提高生存率。Objective To investigate the effect of operation opportunity on therapeutic efficacy of hepatocellular carcinoma(HCC)with rupture hemorrhage.Method A retrospective study of 72 patients with ruptured bleeding HCC inhospitalized from June 2013 to February 2016 was performed,of which 46 patients underwent emergency hepatectomy(emergency surgery group),and 26 patients received delayed hepatectomy after conservative treatment with stable circulation and improved liver function(deferred surgery group).Perioperative indicators of the two groups were recorded,including surgical procedures,intraoperative blood transfusions,intraoperative bleed loss,surgical time,postoperative hospital stay,time of first feeding,and time of first out-of-bed activity.Postoperative follow-up was conducted in the form of outpatient clinics and telephone calls.The deadline for follow-up was January 1,2020.Postoperative survival and tumor recurrence were compared between the two groups.Result There was no significant difference in the surgical methods and operation time between the two groups(P>0.05).Intraoperative bleed loss,intraoperative blood transfusion,time of first feeding and time of first outof-bed activity in emergency surgery group were higher than those in the delayed surgery group,.while the postoperative hospital stay was shorter than the delayed surgery group(P<0.05).The median disease-free survival time in the emergency surgery group and the delayed surgery group were 9.2 months and 8.6 months,respectively,and the abdominal cavity metastasis rates were 32.6%(15/46)and 34.6%(9/26),respectively,and there was no significant difference(P>0.05).However,the recurrence and metastasis rate in the emergency surgery group was significantly lower than that in the delayed surgery group(43.5%vs.69.23%;P<0.05).The overall survival rates of 1,2,and 3 years after surgery in the emergency surgery group was significantly higher than that in the delayed surgery group(84.8%vs.69.2%for 1-year survival rate,76.1%vs.57.7%for 2-year survival rate,45.7%

关 键 词：肝细胞癌 破裂出血 复发转移 手术时机 

分 类 号：R735.7[医药卫生—肿瘤]