肝细胞癌患者行根治外科疗法后的生存状况研究

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摘要目的探讨肝细胞癌患者行根治外科疗法后的生存状况，旨在分析影响患者的预后因素，为临床治疗肝细胞癌提供相应的方向及依据。方法回顾性分析2008年6月～2012年6月在惠州市中心医院（因手术组医师该期间尚在市中心医院工作）接受手术治疗的146例肝细胞癌患者的临床资料，针对所有病例术后5年的生存状况进行系统随访，对所有相关因素进行单因素分析，并对单因素分析有统计学意义的指标进行Cox回归多因素分析。结果146例肝癌患者均顺利完成手术，行解剖性肝切除术80例，非解剖性肝切除术66例。10例患者发生术后并发症，主要并发症为胸腔积液（4例）、切口感染（2例）、术后发热（2例）、肠梗阻（2例），其中部分患者合并多种并发症。术后随访5年，随访时间1～139个月，中位生存时间为59个月，5年总体生存率为47.95%（70/146），失访3例（2.05%）。单因素分析显示，性别、年龄、肝功能分级、肝门阻断、手术方式等因素不是影响肝细胞癌患者行根治外科疗法后生存状况的相关因素（P＞0.05）；肿瘤包膜、天冬氨酸氨基转移酶、微血管浸润、肿瘤大小、肿瘤数目、肿瘤分化程度、总胆固醇、AJCC分期等因素为影响肝细胞癌患者行根治外科疗法后生存状况的相关因素（P＜0.05）。多因素回归显示，肿瘤分化、微血管浸润、肿瘤大小、肿瘤数目、AJCC分期为影响肝细胞癌患者行根治外科疗法后生存状况的独立因素（P＜0.05）。结论解剖性肝切除术、非解剖性肝切除术用于治疗肝细胞癌患者远期效果较好；肿瘤分化、微血管浸润、肿瘤大小、肿瘤数目、AJCC分期为影响肝细胞癌患者行根治外科疗法后生存状况的独立因素。

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	袁波
	廖锦歧
	方永平

关键词 ：肝细胞癌, 根治外科疗法, 生存状况

Abstract：Objective To explore the survival status of patients with hepatocellular carcinoma after radical surgery in order to analyze the prognostic factors and provide direction and basis for clinical treatment of hepatocellular carcinoma.Methods The clinical data of 146 patients with hepatocellular carcinoma undergone surgical treatment from June 2008 to June 2012 in the central hospital(because these surgeons still worked in the Central Hospital of Huizhou)were retrospectively analyzed.All cases were followed up for 5 years after operation.All related factors were analyzed by single factor analysis,after that the Cox regression multiple-factor analysis was carried out if the index was statistically significant after single factor analysis.Results All the participants were successfully performed.Eighty cases were performed with anatomical hepatectomy,and the rest cases were not.Postoperative complications occurred in 10 patients,including pleural effusion(4 cases),incisional infection(2 cases),postoperative fever(2 cases),and intestinal obstruction(2 cases).A-mong them,some patients had multiple complications.After 5-year follow-up,the follow-up was from 1 to 139 months,and the median survival time was 59 months.The total survival rate of 5 years was 47.95% (70/146),and 3 cases were lost accounting for 2.05%.Univariate analysis showed that gender,age,grade of liver function,hepatic portal occlusion,and surgical mode were not related factors influencing on the survival state of patients with hepatocellular carcinoma after radical surgery therapy(P＞0.05).The related factors were tumor capsule,aspartate aminotransferase,microvascular invasion,tumor size,amount of tumor,tumor differentiation,total cholesterol,and AJCC stage(P＜0.05).Multivariate regression analysis displayed that tumor differentiation,microvascular invasion,tumor size,tumor number,and AJCC stage were independent factors that affected the survival status of patients with hepatocellular carcinoma after radical surgery(P＜0.05).Conclusion Both anatomical liver resection and non-anatomical liver resection for the treatment of patients with hepatocellular carcinoma have better long-term effects.Tumor differentiation,microvascular invasion,tumor size,number of tumor,and AJCC stage are independent factors influencing on the survival status of patients with hepatocellular carcinoma after radical surgery.

Key words： Hepatocellular carcinoma Radical surgical treatment Survival status

作者简介: 袁波（1972-），男，汉族，四川遂宁人，中山大学医学硕士，肝胆外科副主任医师，研究方向：肝胆外科

引用本文:

袁波;廖锦歧;方永平. 肝细胞癌患者行根治外科疗法后的生存状况研究[J]. 中国当代医药, 2018, 25(10): 13-15.
YUAN Bo;LIAO Jin-qi;FANG Yong-ping. Research on the survival status of patients with hepatocellular carcinoma after radical surgical treatment. 中国当代医药, 2018, 25(10): 13-15.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2018/V25/I10/13

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