原发性肝细胞癌合并胆道癌栓的手术疗效分析  

Surgical therapy for hepatocellular carcinoma patients with biliary tract tumor thrombus

作　　者：申瑶 黄靖波 张辉 刘亚晖 段小辉 毛先海[1] Shen Yao;Huang Jingbo;Zhang Hui;Liu Yahui;Duan Xiaohui;Mao Xianhai(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital),Changsha 410005,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)肝胆胰外科,长沙410005

出　　处：《中华普通外科杂志》2022年第5期334-338,共5页Chinese Journal of General Surgery

基　　金：湖南省自然科学基金(2019JJ80007)。

摘　　要：目的:探讨原发性肝细胞癌(HCC)合并胆道癌栓患者的手术疗效及影响患者预后的危险因素。方法:回顾性分析2011年1月至2016年12月在湖南师范大学附属第一医院行手术治疗的66例HCC合并胆道癌栓患者的临床资料。结果:66例均行手术治疗,患者总体中位生存时间为31个月,1、3、5年生存率分别为87.9%、45.5%和13.6%。单因素分析显示乙型病毒性肝炎、肝硬化、饮酒史、AFP≥200 ng/ml、肿瘤切除联合胆管切开癌栓取出、肿瘤未分化/低分化、肿瘤直径≥50 mm、AJCC 8thⅢ/Ⅳ期、病灶数目≥2是患者术后生存的危险因素(均P<0.05)。多因素分析显示饮酒史、肿瘤未分化/低分化、肿瘤直径≥50 mm、AJCC 8thⅢ/Ⅳ期是独立危险因素(均P<0.05)。结论:HCC合并胆道癌栓患者行积极的手术治疗可获得较好的生存预后。Objective To evaluate surgical therapy for patients of hepatocellular carcinoma(HCC)with bile duct tumor thrombi(BDTT).Methods A retrospective analysis was made on 66 patients with HCC and BDTT undergoing surgical treatment at the First Affiliated Hospital of Hunan Normal University from Jan 2011 to Dec 2016.Results The overall median survival time of the patients was 31 months.The 1,3,and 5-year survival rates were 87.9%,45.5%,and 13.6%,respectively.Univariate analysis showed hepatitis B virus,liver cirrhosis and history of drinking,AFP≥200 ng/ml,tumor resection combined with biliary incision to remove tumor thrombus,tumor undifferentiated/poorly differentiated,tumor diameter≥50 mm,AJCC 8th stageⅢ/Ⅳand number of lesions≥2 were risk factors for postoperative survival(all P<0.05).Multivariate analysis showed that drinking history,undifferentiated/poorly differentiated tumor,tumor diameter≥50 mm,and AJCC 8thⅢ/Ⅳstage were independent risk factors(all P<0.05).Conclusion Surgical resection of HCC combined with BDTT can achieve a satisfactory survival and prognosis.

关 键 词：癌 肝细胞 胆道 癌栓 

分 类 号：R735.7[医药卫生—肿瘤]