肝癌自发性破裂出血的治疗及预后研究  

Treatment and prognosis of spontaneous rupture hemorrhage of liver cancer

作　　者：贾洪涛 倪庆强 于泽涛 卢俊 常宏 Jia Hongtao;Ni Qingqiang;Yu Zetao;Lu Jun;Chang Hong(Department of Hepatobiliary Surgery,Provincial Hospital Afiliated to Shandong First Medical University,Jinan Shandong Province 250000,China)

机构地区：[1]山东第一医科大学附属省立医院肝胆外科,济南250000

出　　处：《中华普外科手术学杂志（电子版）》2023年第4期408-412,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：山东省2020年自然基金项目资助(ZR2020MH054)。

摘　　要：目的探讨肝细胞癌自发性破裂出血(srHCC)患者行肝癌切除术治疗的预后,并评估是否可新增其分期以补充现行的中国肝癌分期系统(CNLC分期)。方法回顾总结2013年1月至2022年3月119例行根治性手术切除的肝细胞癌(HCC)患者临床资料特征,根据肿瘤情况分为肝癌破裂组(Ⅰ组,n=40)、CNLC分期Ⅱ期组(Ⅱ组,n=34)、CNLC分期Ⅲa期组(Ⅲ组,n=45)。采用SPSS 26.0进行统计学分析。三组间计量资料比较采用单因素方差分析(ANOVA)或Kruskal-Wallis检验。分类变量采用χ^(2)检验。采用Kaplan-Meier法绘制生存曲线,利用Log-Rank法进行生存率的比较,采用COX回归模型进行预后影响因素分析。P<0.05为差异有统计学意义。结果肝癌破裂(HR=2.629,P=0.011)和肿瘤分化程度(HR=3.008,P=0.006)是影响肝癌切除术后总生存时间的独立危险因素。三组患者术后总生存时间差异有统计学意义(P<0.001),肝癌自发性破裂组(Ⅰ组)患者总生存期短于CNLC分期Ⅱ期组(Ⅱ组)(P=0.033),长于CNLC分期Ⅲa期组(Ⅲ组)(P=0.048)。三组患者术后无复发生存时间差异有统计学意义(P=0.029),Ⅰ组分别与Ⅱ组、Ⅲ组的无复发生存时间进行比较显示差异无统计学意义(P值分别为0.748.0.060)。结论肝癌自发性破裂出血是影响患者肝癌切除术后总生存时间的独立危险因素,建议新增CNLCⅢ0期补充至现行的CNLC肝癌分期系统。Objective To investigate the prognosis of patients with spontaneous rupture hemorhage of hepatocellular carcinoma(srHCC)undergoing hepatocellular carcinoma resection,and to evaluate whether additional stages can be added to complement the curent Chinese liver cancer staging system(CNLC staging).Methods The clinical data of 119 patients with hepatoellular carcinoma(HCC)who underwent radical surgical resection from January 2013 to March 2022 were reviewed and summarized.SPSS 26.0 was used for statistical analysis.Measurement data among the three groups were compared using One-way ANOVA or Kruskal-Wallis test.χ^(2) test was used for categorical variables.Kaplan-Meier method was used to draw the survival curve,Log-Ranh method was used to compare the survival rate,and COX regression model was used to analyze the influencing factors of prognosis.P<0.05 was considered statistically significant Results Hepatocellular carcinoma rupture(HR=2.629,P=0.011)and tumor differentiation(HR=3.008,P=0.006)were independent risk factors for overall survival after hepatocellular carcinoma resection.The total survival time of the three groups was statistically different(P<0.001).The total survival time of the spontaneous rupture(Ⅰ)group was shorter than that of the CNLC stageⅡ(Ⅱ)group(P=0.033)and longer than that of the CNLC stageⅢA(Ⅲ)group(P=0.048).The postoperative relapse-free survival time of the three groups had statistical significance(P=0.029).The comparison of relapse-fre survival time of groupⅠwith groupⅡand groupⅢshowed no statistical signifcance(P values 0.748 and 0.060,respectively).Conclusion Spontaneous nupture and hemorrhage of liver cancer is an independent risk factor affecting the overall survival time after hepatectomy.It is suggested to add CNLCⅢ0 stage to the existing CNLC liver cancer staging system.

关 键 词：癌 肝细胞 破裂 自发性 肝切除术 总生存期 无复发生存期 

分 类 号：R735.7[医药卫生—肿瘤]