手术切除联合预防性介入对降低肝癌复发率、提高个体生存率的可行性分析  

Feasibility Analysis of Surgical Resection Combined with Preventive Interventions in Reducing the Recurrence Rate and Improving the Individual Survival Rate of patients with Hepatocellular Carcinoma

作　　者：张龙虎 郭平学 李超 何莹[4] 张旭锋 庞卫东 罗春海[7] ZHANG Long-hu;GUO Ping-xue;LI Chao;HE Ying;ZHANG Xu-feng;PANG Wei-dong;LUO Chun-hai(Department of Medical Imaging,East Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi,710089,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Xi'an Medical College,Xi'an,Shaanxi,710038,China;Minimally invasive pain treatment Center,Tangdu Hospital,Air Force military Medical University,Xi'an,Shaanxi,710038,China;Department of Imaging,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi,710004,China;Department of Imaging,Xianyang Rainbow Hospital,Xianyang,Shaanxi,712021,China;General Surgery Department,Eastern Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Yanliang,Shaanxi,710089,China;Medical Imaging Department,the Second Affiliated Hospital of Xi'an Medical College,Xi'an,Shaanxi,710038,China)

机构地区：[1]西安交通大学第一附属医院东院医学影像科,陕西西安710089 [2]西安医学院第二附属医院肝胆外科,陕西西安710038 [3]空军军医大学唐都医院疼痛微创治疗中心,陕西西安710038 [4]西安交通大学第二附属医院影像科,陕西西安710004 [5]咸阳彩虹医院影像科,陕西咸阳712021 [6]西安交通大学第一附属医院东院普外科,陕西阎良710089 [7]西安医学院第二附属医院医学影像科,陕西西安710038

出　　处：《现代生物医学进展》2020年第15期2872-2876,2924,共6页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81301221)。

摘　　要：目的:探究手术切除联合预防性介入对降低肝癌复发率及提高个体生存率方面的可行性。方法:选择2011年2月至2014年2月于我院接受治疗的76例肝癌患者,单纯接受根治术的31例患者为对照组,接受根治术后6个月内应用预防性介入治疗的45例患者为研究组,对全部病例实施最多48个月的随访,对比两组患者术后1年、2年及3年肝癌复发率、生存率及中位生存期。将研究组患者按照接受介入治疗时间分为A组(1个月内接受介入治疗)、B组(1-2个月接受介入治疗)、C组(2-3个月接受介入治疗)、D组(3-6个月接受介入治疗)4个亚组,对比各组患者1年内复发率。最后分析影响肝癌复发的独立危险因素。结果:(1)研究组患者术后1年、2年及3年复发率均低于对照组(P<0.05),而1年、2年及3年生存率均高于对照组(P<0.05),中位生存期长于对照组(P>0.05);(2)术后2个月内接受预防性介入治疗的A、B亚组患者1年复发率明显低于C、D两组(P<0.05);(3)包膜不完整、肿瘤直径≥5 cm、合并肝硬化与肝癌复发有相关性(P<0.05),将肿瘤包膜是否完整、肿瘤直径、肝硬化3个变量采用多因素Logistic回归分析肝癌术后复发的危险因素,显示肿瘤包膜是否完整与合并肝硬化是肝癌复发的独立危险因素(P<0.05)。结论:肝癌切除术后预防性应用介入治疗能够显著降低肝癌患者术后复发率,提高其生存率,且术后1-2个月实施介入治疗效果最好,包膜不完整、合并肝硬化是导致肝癌复发的独立危险因素。Objective: To explore the feasibility of surgical resection combined with preventive intervention in reducing the recurrence rate of hepatocellular carcinoma and improving individual survival rate. Methods: 76 patients with hepatocellular carcinoma treated in our hospital from February 2011 to February 2014 were selected. 31 patients who underwent radical surgery were selected as the control group, and 45 patients who underwent prophylactic interventional therapy within 6 months after radical surgery were selected as the study group. All patients were followed up for up to 48 months. The recurrence rate, survival rate and median survival time of hepatocellular carcinoma at 1, 2 and 3 years after operation were compared between the two groups. Patients in the study group were divided into 4 subgroups: group A(1 month for interventional therapy), group B(1-2 months for interventional therapy), group C(2-3 months for interventional therapy), and group D(3-6 months for interventional therapy), the recurrence rate of four subgroups within 1 year was compared. Finally, analyze the independent risk factors affecting the recurrence of liver cancer. Results:(1) The recurrence rate of 1, 2 and 3 years after operation in the study group was lower than that in the control group(P<0.05), and the 1, 2, and 3 year survival rates were higher than the control group(P<0.05). The median survival time was longer than that of the control group(P>0.05).(2) The1-year recurrence rate of patients in group A and B who received preventive intervention within 2 months after operation was significantly lower than that in group C and D(P<0.05).(3) Incomplete capsule, tumor diameter ≥5 cm, cirrhosis and liver cancer recurrence were associated(P<0.05). Multivariate Logistic regression analysis was used to determine whether the tumor capsule was intact, tumor diameter and cirrhosis. The risk factors for postoperative recurrence of liver cancer showed that the integrity of the tumor capsule and cirrhosis were independent risk factors for liver

关 键 词：手术切除 肝癌 介入治疗 复发率 生存率 

分 类 号：R735.7[医药卫生—肿瘤]