本文選題：原發(fā)性肝癌　切入點(diǎn)：腫瘤大小　出處：《第三軍醫(yī)大學(xué)學(xué)報(bào)》2017年20期

【摘要】：目的探討合并肝硬化的不同大小肝癌患者臨床資料特點(diǎn)及肝切除術(shù)近遠(yuǎn)期預(yù)后的影響因素。方法回顧性分析第三軍醫(yī)大學(xué)西南醫(yī)院2008-2012年期間因肝癌而接受肝臟切除手術(shù)且具有肝硬化的連續(xù)患者資料共703例。收集患者臨床病理資料并進(jìn)行隨訪。對(duì)可能影響近、遠(yuǎn)期預(yù)后的因素分別進(jìn)行Logistic及Cox回歸分析。結(jié)果 703例患者中,男性638例,女性65例。其中,腫瘤最大直徑5 cm的患者(小肝癌組,ST組)280例(39.8%),腫瘤最大直徑≥5 cm的患者(大肝癌組,LT組)423例(60.2%)。與ST組患者比較,LT組患者術(shù)前甲胎蛋白、天門冬氨酸氨基轉(zhuǎn)移酶(AST)及脈管癌栓發(fā)生率較高,但白蛋白及血小板較低。術(shù)中資料表明LT組患者復(fù)雜手術(shù)比例、術(shù)中失血量、肝門阻斷時(shí)間及手術(shù)時(shí)間都較高。而LT組患者術(shù)后并發(fā)癥的總發(fā)生率也較高(35.0%vs 27.1%,P=0.029)。多因素分析顯示,在ST組中,復(fù)雜手術(shù)(OR:2.755,95%CI:1.196~6.344,P=0.017)是獨(dú)立的危險(xiǎn)因素,而白蛋白水平低于35 g/L(OR:4.049,95%CI:2.105~7.752,P0.01)與手術(shù)時(shí)間240 min(OR:3.044,95%CI:1.912~4.847,P0.01)是LT組獨(dú)立的危險(xiǎn)因素。遠(yuǎn)期預(yù)后分析顯示:LT組患者無(wú)瘤生存時(shí)間(progression-free survival,PFS)和總生存時(shí)間(overall-survival,OS)均比ST組短(P0.01)。多因素分析顯示,在ST組中,癌栓是影響PFS的獨(dú)立危險(xiǎn)因素;而Child-Pugh B級(jí)、癌栓和復(fù)雜手術(shù)是影響OS的獨(dú)立危險(xiǎn)因素。在LT組中,癌栓和手術(shù)時(shí)間240 min均為影響PFS的獨(dú)立危險(xiǎn)因素;而AST40 U/L和癌栓是影響OS的獨(dú)立危險(xiǎn)因素。結(jié)論直徑5 cm的小肝癌較之直徑≥5 cm的大肝癌患者有著更高的近、遠(yuǎn)期生存率。而選擇無(wú)癌栓的大肝癌病例,改善術(shù)前白蛋白、轉(zhuǎn)氨酶水平,提高手術(shù)熟練度及合理使用手術(shù)器械[如射頻消融輔助(radiofrequency ablation assist,RFA)]以縮短手術(shù)時(shí)間,可以降低術(shù)后并發(fā)癥并改善大肝癌手術(shù)治療的預(yù)后。
[Abstract]:Objective to investigate the clinical data and prognostic factors of hepatectomy in patients with liver cancer of different size and size complicated with cirrhosis. Methods Hepatectomy was performed in Southwest Hospital of the third military Medical University from 2008 to 2012. Methods Hepatectomy was performed in Southwest Hospital of the third military Medical University from 2008 to 2012. There were 703 consecutive patients with cirrhosis except surgery. The clinicopathological data of the patients were collected and followed up. The long-term prognostic factors were analyzed by Logistic and Cox regression analysis. Results among 703 patients, 638 were male and 65 were female. There were 280 cases in St group with tumor maximum diameter of 5 cm and 280 cases with tumor maximum diameter 鈮，

本文編號(hào)：1675948