解剖性肝切除术治疗原发性肝癌合并微血管侵犯患者的复发情况及其影响因素分析  

Anatomical hepatectomy for the recurrence of patients with primary hepatocellular carcinoma with microvascular invasion and analysis of its influencing factors

作　　者：杨培[1] 曾新桃[1] 罗华[1] 张伟[1] YANG Pei;ZENG Xin-tao;LUO Hua(Department of Hepatobiliary Surgery,Mianyang Central Hospital,Mianyang Sichuan 621000,China)

机构地区：[1]绵阳市中心医院肝胆外科,四川绵阳621000

出　　处：《临床和实验医学杂志》2021年第16期1727-1730,共4页Journal of Clinical and Experimental Medicine

基　　金：四川省卫生健康委员会科研项目(编号:19PJ115)。

摘　　要：目的观察记录解剖性肝切除术(AR)治疗原发性肝细胞癌(PHC)合并微血管侵犯(MVI)患者的术后早期复发情况,并分析其影响因素。方法回顾2016年5月至2018年5月绵阳市中心医院收治的PHC患者129例的临床资料,依据微血管侵犯(MVI)病理检查结果,分为MVI+组(阳性)与MVI-组(阴性),比较两组AR术治疗后2年复发率及生存情况。再以是否复发为依据,分为复发组与未复发组,探讨分析AR术治疗PHC患者早期预后的影响因素。结果 MVI+组的复发率(40.47%)与MVI-组复发率(35.63%)相比,差异无统计学意义(P>0.05);MVI+组生存率(47.61%)明显低于MVI-组(66.67%),差异有统计学意义(P<0.05)。Ⅲ~Ⅳ期、肿瘤直径> 5 cm、多发肿瘤、肿瘤包膜完整与否是影响PHC合并MVI患者AR术后早期复发的独立危险因素(P<0.05)。结论对于PHC合并MVI患者,AR术治疗能够提高患者术后生存率,使患者获得较好预后;肿瘤分期为Ⅲ~Ⅳ期、肿瘤直径> 5 cm、多发肿瘤、肿瘤包膜完整性为影响PHC合并MVI患者AR术后早期复发的独立危险因素,临床治疗中应予以重视。Objective To observe and record the early postoperative recurrence of patients with primary hepatocellular carcinoma(PHC)combined with micro-vascular invation(MVI) treated by anatomical resection(AR). And analyze its influencing factors. Methods The clinical data of 129 PHC patients admitted to Mianyang Central Hospital from May 2016 to May 2018 were reviewed. Based on the results of microvascular invasion(MVI) pathological examination,they were divided into MVI + group(positive) and MVI-group(negative). The two-year recurrence rate and survival after AR treatment were compared between the two groups. Based on the recurrence or not,they were divided into recurrence group and non-recurrence group to discuss and analyze the factors affecting the early prognosis of PHC patients treated with AR surgery.Results Compared with the recurrence rate of MVI + group(40. 47%) and the recurrence rate of MVI-group(35. 63%),the difference was not statistically significant(P>0.05). The survival rate of the MVI + group(47. 61%) was significantly lower than that of the MVI-group(66. 67%),and the difference was statistically significant(P<0.05). The results of multivariate logistic regression analysis showed that tumor staging of stage Ⅲ ~ Ⅳ,tumor diameter > 5 cm,multiple tumors,and tumor envelope integrity were independent risk factors for early recurrence after AR in PHC patients with MVI(P<0.05). Conclusion For patients with PHC combined with MVI,AR surgery can improve the survival rate of patients after surgery and obtain a better prognosis. The tumor stage is Ⅲ ~ Ⅳ,tumor diameter > 5 cm,multiple tumors,and tumor envelope integrity affect PHC combined Clinical treatment should be paid attention to the independent risk factors of early recurrence after AR in MVI patients.

关 键 词：原发性肝癌 微血管侵犯 解剖性肝切除术 复发情况 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]