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肝细胞癌自发性破裂出血行肝切除术的疗效及生存分析
Surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy
文章发布日期:2018年12月17日  来源:  作者:王新伟,王维娜,张宗利  点击次数:152次  下载次数:16次

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【摘要】:目的探讨肝细胞癌自发性破裂出血行肝切除术的手术疗效及生存分析。方法选取2008年1月-2016年6月日照市中医医院收治且行肝切除术的68例肝细胞癌自发性破裂出血患者,分析围手术期情况、术后生存及相关危险因素。采用Kaplan-Meier法计算累积生存率,影响预后的单因素分析采用log-rank检验,将单因素分析中有意义的危险因素再使用Cox回归模型进行多因素分析。结果术后3例患者死亡,围手术期病死率为4.41%。余65例患者中,14例(21.54%)术后出现严重并发症。61例患者获得随访,随访率为93.85%。中位总生存期为14.0个月,1、3、5年累积总生存率分别为52.5%、28.6%、11.8%;中位无瘤生存期11.9个月,1、3、5年累积无瘤生存率分别为47.5%、21.2%、10.6%。单因素分析结果显示,术后总生存期与Child-Pugh分级、AFP水平、肿瘤大小、肿瘤个数、脉管侵犯和术后严重并发症有关(χ2值分别为4.201、5.291、5.926、6.327、5.062、5.028,P值均<0.05);Cox多因素分析结果显示,肿瘤直径≥10 cm[相对危险度(RR)=3.688,95%可信区间(95%CI):1.211~11.227,P=0.034]、多发肿瘤(RR=4.158,95%CI:1.092~15.827,P=0.027)、脉管侵犯(RR=0.206,95%CI:0.078~0.540,P=0.034)和术后严重并发症(RR=0.283,95%CI:0.086~0.929,P=0.025)是术后总生存期的独立危险因素。结论肝细胞癌自发性破裂出血患者行肝切除术后围手术期病死率和并发症发生率较高,术后总体生存情况较差。其中,肿瘤直径较大、多发肿瘤、合并脉管侵犯及术后出现严重并发症患者的生存期更短。
【Abstract】:ObjectiveTo investigate the surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy. MethodsA total of 68 patients with spontaneous rupture and bleeding of hepatocellular carcinoma who were admitted to Rizhao Municipal Hospital of Traditional Chinese Medicine from January 2008 to June 2016 and underwent hepatectomy were enrolled, and their perioperative conditions, postoperative survival, and risk factors were analyzed. The Kaplan-Meier method was used to calculate cumulative survival rate; the log-rank test was used for the univariate analysis of prognostic factors, and the Cox regression model was used for the multivariate analysis of the risk factors with statistical significance identified by the univariate analysis. ResultsOf all patients, 3 died after surgery, resulting in a perioperative mortality rate of 4.41%; among the other 65 patients, 14 (21.54%) experienced serious complications after surgery. A total of 61 patients were followed up, and the follow-up rate was 93.85%. The median overall survival time was 14.0 months and the 1-, 3-, and 5-year cumulative overall survival rates were 52.5%, 28.6%, and 11.8%, respectively. The median disease-free survival time was 10.9 months and the 1-, 3-, and 5-year cumulative disease-free survival rates were 47.5%, 21.2%, and 10.6%, respectively. The univariate analysis showed that overall postoperative survival time was associated with Child-Pugh class, alpha-fetoprotein level, tumor size, number of tumors, vascular invasion, and serious complications after surgery (χ2=4.201, 5.291, 5.926, 6.327, 5.062, and 5.028, all P<0.05). The Cox multivariate analysis showed that a tumor diameter of ≥10 cm (relative risk [RR]=3.688, 95% confidence interval [CI]: 1.211-11.227, P=0.034), multiple tumors (RR=4.158, 95%CI: 1.092-15.827, P=0.027), vascular invasion (RR=0.206, 95%CI: 0.078-0.540, P=0.034), serious complications after surgery (RR=0.283, 95%CI: 0.086-0.929, P=0.025) were independent risk factors for overall postoperative survival time. ConclusionPatients with spontaneous rupture and bleeding of hepatocellular carcinoma have high perioperative mortality rate and incidence rate of complications after hepatectomy, with poor overall survival after surgery. The patients with large tumors, multiple tumors, vascular invasion, and serious complications after surgery tend to have a short survival time.
【关键字】:癌, 肝细胞; 破裂, 自发性; 肝切除术; 危险因素
【Key words】:carcinoma, hepatocellular; rupture, spontaneous; hepatectomy; risk factors
【引证本文】:WANG XW, WANG WN, ZHANG ZL. Surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy[J]. J Clin Hepatol, 2019, 35(1): 114-118. (in Chinese)
王新伟, 王维娜, 张宗利. 肝细胞癌自发性破裂出血行肝切除术的手术疗效及生存分析[J]. 临床肝胆病杂志, 2019, 35(1): 114-118.

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