AFP阴性肝癌患者手术疗效和预后影响因素分析  

Analysis of factors influencing surgical efficacy and prognosis in patients with AFP-negative hepatocellular carcinoma

作　　者：马平川 陈子祥 赵义军[1] 刘付宝[1] MA Ping-chuan;CHEN Zi-xiang;ZHAO Yi-jun(The First Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《肝胆外科杂志》2024年第1期16-20,共5页Journal of Hepatobiliary Surgery

基　　金：2021年度安徽高校自然科学研究项目(KJ2021ZD0021)。

摘　　要：目的探讨AFP阴性肝癌患者切除术后治疗及预后分析。方法回顾性分析安徽医科大学第一附属医院肝胆胰外科2015年7月至2020年7月480例行肝切除术的AFP阴性肝癌患者的临床资料。男性409例,女性71例;年龄为(58±11)岁。观察指标:(1)AFP阴性患者术后情况。(2)AFP阴性肝癌的危险因素分析。(3)AFP阴性肝癌预后的预测模型构建。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann-WhitneyU检验。计数资料以绝对数或百分比表示,组间比较采用x^(2)检验或Fisher确切概率法。单因素和多因素分析采用Cox比例风险模型。结果(1)一般情况:本研究最终纳人研究共480例患者。男性409例,女性71例,患者平均发病年龄58岁。大血管侵犯22例,MV1107例,胆管癌栓16例,肿瘤多发65例,肿瘤平均直径57mm,最大肿瘤直径200mm,肿瘤分化Ⅰ~Ⅱ级392例,Ⅲ~Ⅳ级88例,TNM Ⅰ-Ⅱ期388例,Ⅲ~Ⅳ期92例,肝硬化324例,乙肝411例,CA19-9阳性72例。(2)手术情况:有267例达到解剖性肝切除,155例大于2个肝段切除,20例行扩大肝切除,所有患者均达到R0切除,248例术中行肝门阻断,56例联合其他手术。患者手术时间为(230±80)min,术中出血量为800(5001200)mL,术中输血率为23.1%(111/480)。(3)术后情况:患者术后并发症发生率为28.12%(135/480),严重并发症Clavien-Dindo分级Ⅲ级57例,其中胸腔或腹腔穿刺抽积液29例,术后出血12例,Ⅳ级16例,肝衰13例,3例术后严重感染引起的感染性休克,转入ICU治疗后均好转顺利出院。480例患者中,合并胆汁漏5例,合并肺部感染30例,合并切口感染6例,保守治疗后均好转。术后住院时间为(16±7)d。(4)随访情况:525例患者中45例患者失访或病例资料不完整,最终纳入480例患者,其中复发258例,死亡217例,其中因肝癌死亡182例。平均无瘤生存期为38个月,总生存期为48个月。1年存活�Objective To investigate the treatment and prognosis analysis of AFP-negative hepatocellular carcinoma patients after resection.Methods Clinical data of 480 AFP-negative hepatocellular carcinoma patients who underwent hepatectomy from July 2015 to July 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.There were 409 males and 71 females;the age was(58±11)years old.Observation indexes:(1)Postoperative condition of AFP-negative patients.(2)Risk factor analysis of AFP-negative hepatocellular carcinoma.(3)Predictive model construction for the prognosis of AFP-negative hepatocellular carcinoma.Measures with normal distribution were expressed as x+s,and independent samples t test was used for comparison between groups;measures with skewed distribution were expressed as M(range),and Mann-Whitney U test was used for comparison between groups.Count data were expressed as absolute numbers or percentages,and comparisons between groups were made using the X^(2)test or Fishers exact probability method.Cox proportional risk model was used for univariate and multivariate analyses.Results(1)GENERAL:A total of 480 patients were finally included in this study.There were 409 males and 71 females,and the average age of onset of the patients was 58 years old.There were 22 cases of macrovascular invasion,107 cases of MVI,16 cases of cholangiocarcinoma embolus,65 cases of tumor multiplicity,the average diameter of tumor was 57mm,the maximum diameter of tumor was 200mm,the differentiation of tumor was I~II grade in 392 cases,II~V grade in 88 cases,the TNM I~II stage in 388 cases,II~IV stage in 92 cases,crrhosis of liver was in 324 cases,Hepatitis B was in 411 cases,and CA19-9 was positive in 72 cases.(2)Surgery:267 cases reached anatomical hepatectomy,155 cases were resected in more than 2 liver segments,20 cases were extended hepatectomy,all patients reached RO resection,248 cases were intraoperative hepatic portal block,56 cases we

关 键 词：甲胎蛋白阴性 肝细胞癌 预后 

分 类 号：R735.7[医药卫生—肿瘤]