本文選題：肝細胞癌 + 手術方式�。� 參考：《第二軍醫(yī)大學》2017年碩士論文

【摘要】：研究目的:原發(fā)性肝癌是世界第5大惡性腫瘤,第3大致死性腫瘤。隨著人們健康意識的提高,越來越多肝細胞癌在早期發(fā)現(xiàn),因此早期肝癌的治療變得愈加重要。目前早期肝癌的治療方式包括肝移植術、肝切除術等,兩種手術方式各有特點,篩選適合的早期肝癌的手術方式將會使患者受益。研究表明微血管侵犯(MVI)是影響肝切除術和肝移植術預后較重要的危險因素,因此有無微血管侵犯可能會對不同手術方式的預后產生重要影響。為了評價MVI對手術方式的影響,本文通過分析肝切除術和肝移植術在有無MVI兩組的預后差異判斷適合患者最佳的手術方式,并基于術前指標預測術后肝癌MVI發(fā)生的Nomogram比較肝切除術和肝移植術的術后遠期療效差異。研究方法:1、病歷資料回顧性分析了我院2008年1月至2010年12月連續(xù)的905例行肝切除術的米蘭標準內乙型病毒肝炎相關的原發(fā)性肝癌患者的臨床病理資料及長征醫(yī)院于2001年1月至2015年12月連續(xù)的117例行肝移植術的米蘭標準內乙型病毒肝炎相關的原發(fā)性肝細胞癌患者的臨床病例資料。2、手術方式行肝切除術的全部患者為根治性切除,切緣至腫瘤邊緣至少0.5cm,門阻斷時間不超過20分鐘。肝移植術至少由經驗豐富的3位醫(yī)師執(zhí)行。3.隨訪所有患者術后采用電話隨訪或門診隨訪,2年內每2個月隨訪一次,2年后每3個月隨訪一次。4.統(tǒng)計方法(1)通過R語言c-index驗證Nomogram的正確性(2)分別在肝切除組和肝移植組驗證建立生存分析和單多因素分析驗證微血管侵犯高低危的臨床意義(3)連續(xù)正態(tài)分布變量用均數(shù)±標準差表示,分類變量采用例數(shù)(百分比)表示。分類變量比較采用卡方檢驗或Fisher確切概率法,連續(xù)變量比較采用Kruskal-Wallis檢驗,生存曲線繪制采用Kaplan-Meier法,單因素分析采用log-rank檢驗,多因素分析采用cox比例風險模型,P0.05認為有統(tǒng)計學意義。研究結果:第一部分:1.1022例米蘭標準內乙肝相關的原發(fā)性肝癌患者包括905例行肝切除術和117例行肝移植術的患者,肝移植組和肝切除組術后總體生存相似,但肝移植組術后復發(fā)率更低。2.MVI陽性組中,肝移植組的術后復發(fā)和總體生存結果均較肝切除組好3.MVI陰性組中,肝移植組的術后腫瘤復發(fā)和總體生存結果較肝切除組均無統(tǒng)計學差異第二部分:1.Nomogram的驗證:905例肝切除組患者中,Nomogram的C-index值為0.721;肝移植組中Nomogram的C-index為0.705。2.Nomogram分組的臨床意義:肝切除組和肝移植組中MVI高危組預后均教MVI低危組差。第三部分:1.建立MVI高危組和MVI低危組基本表,因臨床特征有差異,進行PSM。2.PSM后MVI高危組中,肝移植組的術后復發(fā)和總體生存結果均較肝切除組好。3.PSM后MVI低危組中,肝移植組的術后復發(fā)和總體生存結果較肝切除組無統(tǒng)計學差異。4.多因素分析顯示手術方式是影響MVI高危組患者的獨立危險因素,對MVI低危組患者無顯著影響。研究結論:在MVI陽性組中,肝移植術的預后要好于肝切除術,在MVI陰性組中,肝移植組和肝切除組具有相似的預后。Nomogram具有較好的預測能力,且臨床意義顯著。在MVI低危組中,肝切除組和肝移植組具有相似的預后,在MVI高危組中,肝移植組患者預后較好。
[Abstract]:Objective: primary liver cancer (HCC) is the fifth largest malignant tumor in the world and third roughly dead tumors. With the improvement of people's health awareness, more and more hepatocellular carcinoma are found early, so the treatment of early liver cancer is becoming more and more important. At present, the treatment methods of early liver cancer include liver transplantation, hepatectomy and so on, and the two kinds of surgical methods have their own characteristics, The screening of appropriate surgical methods for early liver cancer will benefit patients. Studies have shown that microvascular invasion (MVI) is an important risk factor affecting the prognosis of hepatectomy and liver transplantation. Therefore, whether or not microvascular invasion may have an important impact on the prognosis of different surgical methods. In order to evaluate the effect of MVI on the mode of operation, this article works Over analysis of hepatectomy and liver transplantation in the MVI two groups to determine the difference in the prognosis of the patients to determine the best way of operation, and based on preoperative indicators to predict the incidence of hepatocellular carcinoma MVI after the Nomogram comparison of hepatectomy and liver transplantation long-term effect difference. Research methods: 1, retrospective analysis of our hospital from January 2008 to 2010 Clinicopathological data of hepatitis B related primary liver cancer patients in the Milan standard of 905 consecutive cases of hepatectomy in December, and the clinical data of patients with hepatitis B related primary hepatocellular carcinoma (.2) in the Milan standard from January 2001 to December 2015 in the Milan standard from January 2001 to December 2015. All the patients undergoing hepatectomy were radical excision, cutting edge to the edge of the tumor at least 0.5cm, and the door blocking time was not more than 20 minutes. Liver transplantation was performed at least 20 minutes by 3 experienced physicians. All patients were followed up by telephone or outpatient follow-up after operation, followed up every 2 months in 2 years, and followed up every 3 months after 2 years. Statistical methods (1) verify the correctness of Nomogram through the R language c-index (2) to verify the clinical significance of survival analysis and single factor analysis in hepatectomy group and liver transplantation group, respectively, to verify the clinical significance of the high and low risk of microvascular invasion (3) continuous normal distribution variables are expressed in mean number + standard deviation, the number of classified variables is represented by the number of cases (percentage). Compared using chi square test or Fisher exact probability method, continuous variable comparison using Kruskal-Wallis test, survival curve drawing using Kaplan-Meier method, single factor analysis using log-rank test, multifactor analysis using Cox proportional hazard model, P0.05 think there is statistical significance. The first part: 1.1022 cases of hepatitis B in Milan standard The patients with primary liver cancer included 905 cases of hepatectomy and 117 cases of liver transplantation. The overall survival of the liver transplantation group and the hepatectomy group was similar, but the recurrence rate of the liver transplantation group was lower in the.2.MVI positive group. The postoperative recurrence and overall survival of the liver transplantation group were better in the 3.MVI negative group than the hepatectomy group, and the liver transplantation group was better than the liver transplantation group. There were no statistical differences between the postoperative tumor recurrence and the total survival results compared with the hepatectomy group: 1.Nomogram validation: in 905 patients with hepatectomy, the C-index value of Nomogram was 0.721; the C-index of Nomogram in the liver transplantation group was the clinical significance of the 0.705.2.Nomogram group: the prognosis of the high-risk group of MVI in the hepatectomy group and the liver transplantation group were all MV. I low risk group difference. Third: 1. to establish a high risk group of MVI and the basic table of MVI low risk group, because of the difference in clinical characteristics, in the high risk group of MVI after PSM.2.PSM, the postoperative recurrence and the overall survival result of the liver transplantation group are better than the.3.PSM in the low risk group of the hepatectomy group, and the postoperative recurrence and the overall survival results of the liver transplantation group are not statistically significant compared with the hepatectomy group. .4. multivariate analysis showed that the surgical method was an independent risk factor affecting the patients in the high risk group of MVI and had no significant influence on the patients in the low risk group of MVI. Conclusion: in the MVI positive group, the prognosis of the liver transplantation is better than that of the hepatectomy. In the MVI negative group, the prognosis of the liver transplantation group and the hepatectomy group is better than that of the hepatectomy group. In the low risk group of MVI, the hepatectomy group and the liver transplantation group have similar prognosis. In the high risk group of MVI, the patients in the liver transplantation group have a better prognosis.

【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7

【參考文獻】

相關期刊論文 前1條

1 Harry Hua-Xiang Xia;;Novel therapeutic approaches for hepatocellulcar carcinoma: Fact and fiction[J];World Journal of Gastroenterology;2008年11期

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本文編號：1813048