本文關(guān)鍵詞：HCC術(shù)后超早期復(fù)發(fā)的危險因素分析及DSA與增強CT對其診斷價值的對比研究　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肝細(xì)胞肝癌 肝部分切除術(shù) 術(shù)后復(fù)發(fā) 危險因素 肝動脈DSA 增強CT

【摘要】：第一部分HCC術(shù)后超早期復(fù)發(fā)的危險因素分析目的:探討肝細(xì)胞肝癌(HCC)術(shù)后超早期復(fù)發(fā)的相關(guān)因素,從而為HCC術(shù)后超早期復(fù)發(fā)的臨床預(yù)防及早期診治提供科學(xué)依據(jù)。方法:回顧性分析河北醫(yī)科大學(xué)附屬第四醫(yī)院2015年12月-2016年6月期間收治肝癌患者臨床資料。并根據(jù)以下標(biāo)準(zhǔn)篩選:入組標(biāo)準(zhǔn):1、初次診為原發(fā)性肝癌,且行肝部分切除術(shù),達到I級切除,術(shù)后病理為HCC;2、術(shù)前影像學(xué)資料齊全,未發(fā)現(xiàn)淋巴結(jié)轉(zhuǎn)移及遠(yuǎn)處轉(zhuǎn)移;3、術(shù)前肝功能Child-Pugh分級為A級或部分肝功能較好的B級。排除標(biāo)準(zhǔn):1、之前診為肝癌,本次為復(fù)發(fā)患者;2、術(shù)前行化療、TACE、消融等治療。從術(shù)后第1天算起,每位患者隨訪期為6個月。術(shù)后超早期復(fù)發(fā)標(biāo)準(zhǔn):術(shù)后6個月內(nèi)復(fù)發(fā)。本研究對患者一般資料(性別、年齡)、影像學(xué)資料(腫瘤大小、位置及數(shù)量)、檢驗學(xué)資料(包括HBsAg、乙肝病毒載量(HBV-DNA)、血清AFP、術(shù)前γ-谷氨酰轉(zhuǎn)肽酶(GGT)、谷丙轉(zhuǎn)氨酶(ALT)、總膽紅素(TIBL)、中性粒細(xì)胞計數(shù)/淋巴細(xì)胞計數(shù)(NLR))、病理學(xué)資料(肝硬化程度、腫瘤有無完整包膜、衛(wèi)星灶及肉眼門脈瘤栓)及術(shù)中治療資料(手術(shù)切緣、術(shù)中有無輸血、腹水、肝癌破裂出血及第一肝門阻斷時間)等相關(guān)臨床病例因素,共21項可能影響肝細(xì)胞肝癌術(shù)后超早期復(fù)發(fā)的相關(guān)因素進行統(tǒng)計學(xué)分析,上述變量采用單因素和多因素logistics回歸分析。共篩選出符合上述入選及排除標(biāo)準(zhǔn)病例共146例;超早期復(fù)發(fā)組,共55例;剩余91例歸入未復(fù)發(fā)組。結(jié)果:單因素Logistic回歸分析結(jié)果表明:性別、腫瘤大小、腫瘤數(shù)目、HBV-DNA、血清AFP、術(shù)前GGT、腫瘤周圍有無衛(wèi)星灶、肉眼門脈瘤栓、有無肝癌破裂出血9項因素對術(shù)后超早期復(fù)發(fā)有影響,其差異均有統(tǒng)計學(xué)意義(P0.05)。多因素Logistic回歸分析結(jié)果發(fā)現(xiàn):性別、腫瘤數(shù)量、血清AFP、HBV-DNA、肉眼門脈瘤栓、有無肝癌破裂出血對HCC術(shù)后超早期復(fù)發(fā)影響較大,差異有明顯統(tǒng)計學(xué)意義(P0.05)。第二部分DSA與增強CT對HCC術(shù)后復(fù)發(fā)的診斷價值的對比研究目的:對比肝動脈數(shù)字減影血管造影(DSA)及增強CT對HCC術(shù)后復(fù)發(fā)的診斷價值。方法:收集河北醫(yī)科大學(xué)第四醫(yī)院2015年12月-2016年6月收治的肝癌患者,入院診斷為原發(fā)性肝癌,且行肝部分切除術(shù),術(shù)后病理為HCC。隨訪期為6個月,并收集其隨訪期內(nèi)增強CT及DSA檢查圖像。術(shù)后隨訪期內(nèi)復(fù)發(fā)患者,選取檢出復(fù)發(fā)當(dāng)次增強CT及DSA檢查圖像行對比研究;未復(fù)發(fā)患者,選取隨訪期內(nèi)末次增強CT及DSA檢查圖像行對比研究。所選對比影像學(xué)資料,間隔不超過7天。共134名入組患者,金標(biāo)準(zhǔn)診斷為復(fù)發(fā)共55例,未復(fù)發(fā)患者共79例,隨訪期共有127名患者行增強CT檢查,總計216次,單個病人隨訪期內(nèi)最多行4次;共109名患者行DSA檢查,總計141次,單個病人隨訪期內(nèi)最多共行3次。結(jié)果:按照上述選取標(biāo)準(zhǔn),共選取123次增強CT及105次DSA評價兩種檢查方法的優(yōu)劣,其中增強CT檢查診斷的敏感性為80.7%,特異性為97.2%,準(zhǔn)確性為90.2%。與之相比DSA檢查診斷的敏感性為97.9%,特異性為91.4%,準(zhǔn)確性為94.3%。增強CT及DSA檢查的ROC曲線下面積分別為0.866(95%CI 0.785-0.948)和0.939(95%CI 0.883-0.994)。結(jié)論:1患者性別、HBV-DNA、術(shù)前血清AFP、GGT、NLR、腫瘤大小、數(shù)目,腫瘤周圍是否存在“衛(wèi)星灶”、有無肉眼門脈瘤栓及肝癌破裂出血可能是HCC術(shù)后超早期復(fù)發(fā)的影響因素。2患者性別、HBV-DNA、術(shù)前血清AFP、腫瘤數(shù)量、有無肉眼門脈瘤栓及肝癌破裂出血是HCC術(shù)后超早期復(fù)發(fā)的獨立危險因素。3肝動脈DSA及增強CT檢查對HCC術(shù)后復(fù)發(fā)均有較高的敏感性、特異性及準(zhǔn)確性。對HCC術(shù)后復(fù)發(fā)的診斷價值,肝動脈DSA檢查優(yōu)于增強CT。
[Abstract]:The first part of the risk factors after HCC ultra early recurrence analysis objective: To investigate the hepatocellular carcinoma (HCC) related factors of postoperative early recurrence, provide scientific basis for clinical prevention and early diagnosis and early recurrence of super after HCC. Methods: retrospective analysis of clinical data of December 2015 in the Fourth Affiliated Hospital of Hebei Medical University during June -2016 from patients with liver cancer. According to the following criteria: screening group: 1, the initial diagnosis of primary liver cancer, and underwent partial hepatectomy, level I resection, postoperative pathological diagnosis was HCC; 2, preoperative imaging information Liao Qiquan, found no lymph node metastasis and distant metastasis; 3, preoperative liver function Child-Pugh grade B or a part of liver function better. Exclusion criteria: 1, before the diagnosis of hepatocellular carcinoma, the recurrent patients; 2, preoperative chemotherapy, TACE ablation therapy. After first days from the date, all the patients were followed up for 6 Month after surgery. Ultra early recurrence criteria: recurrence within 6 months after the operation. The research on the general data of patients (gender, age), imaging data (tumor size, location and number), test data (including HBsAg, hepatitis B virus (HBV-DNA), preoperative serum AFP, gamma Valley transpeptidase (GGT), alanine aminotransferase (ALT), total bilirubin (TIBL), neutrophil / lymphocyte count (NLR)), pathology (liver cirrhosis, tumor without complete capsule, satellite lesions and macroscopic portal vein thrombosis) treatment data and intraoperative incision (margin, intraoperative blood transfusion, ascites, liver rupture and Pringle time) and other related clinical factors, a total of 21 possible factors related to hepatocellular carcinoma after ultra early recurrence were analyzed statistically, the variables using univariate and multivariate logistics regression analysis were screened out and meet the exclusion. The selected The standard 146 cases; ultra early recurrence group, a total of 55 cases; the remaining 91 cases in the non recurrent group. Results: univariate Logistic regression analysis showed that sex, tumor size, tumor number, serum HBV-DNA, AFP, GGT before operation, there is no satellite lesions around the tumor, portal vein tumor thrombus with naked eye, no rupture of hepatocellular carcinoma: 9 factors of early postoperative recurrence, the differences were statistically significant (P0.05). Logistic regression analysis results showed: gender, tumor number, serum AFP, HBV-DNA, portal vein tumor thrombus with the naked eye, no liver rupture of blood on the postoperative recurrence of HCC early influence and there was a significant difference (P0.05). The second part DSA and enhanced CT for the purpose of comparison of the diagnostic value of recurrence after HCC: comparison of hepatic artery digital subtraction angiography (DSA) and enhanced the value of CT in the fault diagnosis of HCC recurrence after surgery. Methods: from the Hebei Medical University Four December 2015 -2016 year in June from HCC patients, diagnosed as primary liver cancer, and underwent partial hepatectomy, postoperative pathological HCC. follow-up period of 6 months, and collect the follow-up enhanced CT and DSA imaging. Recurrence during the follow-up period after surgery, recurrence time when selecting detection enhanced CT and DSA examination for comparative study of image; no recurrence at the end of the follow-up period, selection of enhancement of contrast image of CT and DSA examination. The selected contrast imaging data, at intervals of not more than 7 days. A total of 134 patients were enrolled as the gold standard for the diagnosis of recurrence in 55 cases, no relapse patients the follow-up period in 79 cases, a total of 127 patients underwent enhanced CT examination, a total of 216 times, a single patient follow-up period up to 4 times; a total of 109 patients underwent DSA examination, a total of 141 times, a single patient follow-up period up to a total of 3. Results: according to the selection criteria, a total of 123 times enhancement CT and 105 Two kinds of method in the evaluation of the merits of DSA, which enhanced the sensitivity of CT diagnosis was 80.7%, the specificity was 97.2%, accuracy was 90.2%. sensitivity compared with the diagnosis of DSA was 97.9%, the specificity was 91.4%, accuracy was 94.3%. CT enhanced ROC curve area and DSA examination were 0.866 (95%CI and 0.785-0.948) 0.939 (95%CI 0.883-0.994). Conclusion: 1 patients with gender, preoperative serum AFP, HBV-DNA, GGT, NLR, tumor size, tumor number, around whether there is "satellite focus", there is no gross portal vein tumor thrombosis and hemorrhage of ruptured hepatocellular carcinoma may be.2 patients gender, influencing factors of postoperative early recurrence of HCC super HBV-DNA, preoperative serum AFP, tumor number, there is no gross portal vein tumor thrombosis and rupture of liver cancer were independent risk factors of.3 hepatic artery DSA HCC after ultra early recurrence and enhanced CT sensitivity to recurrence were higher after HCC, specificity and accuracy In the diagnosis of postoperative recurrence of HCC, the DSA examination of the hepatic artery is superior to that of the enhanced CT.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R730.44

【參考文獻】

相關(guān)期刊論文 前10條

1 Rodolfo Sacco;Valeria Mismas;Sara Marceglia;Antonio Romano;Luca Giacomelli;Marco Bertini;Graziana Federici;Salvatore Metrangolo;Giuseppe Parisi;Emanuele Tumino;Giampaolo Bresci;Ambra Corti;Manuel Tredici;Michele Piccinno;Luigi Giorgi;Carlo Bartolozzi;Irene Bargellini;;Transarterial radioembolization for hepatocellular carcinoma:An update and perspectives[J];World Journal of Gastroenterology;2015年21期

2 Parissa Tabrizian;Sasan Roayaie;Myron E Schwartz;;Current management of hepatocellular carcinoma[J];World Journal of Gastroenterology;2014年30期

3 朱倩;喬國梁;晏建軍;吳孟超;嚴(yán)以群;;乙肝肝硬化相關(guān)早期肝癌切除術(shù)預(yù)后[J];中華肝膽外科雜志;2014年04期

4 鮮勝;付蓉;;GGT、GGT/CHE、GGT/ALT在肝癌診斷中的價值分析[J];中國醫(yī)藥導(dǎo)刊;2013年11期

5 李征;米登海;楊克虎;曹農(nóng);田金徽;馬彬;劉雅莉;;肝動脈化療栓塞術(shù)聯(lián)合氬氦刀治療肝癌療效及安全性的系統(tǒng)評價[J];中國循證醫(yī)學(xué)雜志;2013年01期

6 Qian Zhu;Jing Li;Jian-Jun Yan;Liang Huang;Meng-Chao Wu;Yi-Qun Yan;;Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma[J];World Journal of Gastroenterology;2012年48期

7 叢文銘;吳孟超;;肝癌術(shù)后復(fù)發(fā)發(fā)生機制及臨床病理學(xué)意義[J];中國實用外科雜志;2012年10期

8 楊浩;楊連粵;;肝癌術(shù)后復(fù)發(fā)轉(zhuǎn)移相關(guān)因素研究進展[J];中國實用外科雜志;2012年10期

9 黃傳鐘;林科燦;王斌;黃愛民;陳慧菁;陶璇;劉景豐;葉韻斌;;肝癌切除肝缺血再灌注損傷前后的蛋白質(zhì)組學(xué)變化[J];中國組織工程研究;2012年40期

10 麥聰;唐云強;洪健;湯凱雯;唐輝;;原發(fā)性肝癌術(shù)后早期復(fù)發(fā)的相關(guān)因素研究[J];臨床合理用藥雜志;2012年18期

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