本文選題：肝細胞癌 + 微血管侵犯��； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討影響單發(fā)肝細胞癌合并微血管侵犯(Microvascular invasion,MVI)患者預(yù)后因素,為合并MVI肝癌患者的臨床治療及預(yù)后評估提供理論依據(jù)。方法:回顧性分析廣西醫(yī)科大學腫瘤醫(yī)院肝膽外科2012年1月至2014年12月行肝細胞癌根治性手術(shù)切除的患者的病例資料,選取其中為單發(fā)肝癌且術(shù)后病理明確提示MVI存在的共152例患者的病例及隨訪資料,分析影響合并MVI的單發(fā)肝細胞癌預(yù)后的相關(guān)因素,具體包括:患者性別,年齡,谷草轉(zhuǎn)氨酶,谷丙轉(zhuǎn)氨酶,白蛋白,總膽紅素,血小板,凝血時間,谷氨酰轉(zhuǎn)肽酶,乙肝表面抗原陽性與否,肝硬化與否,腫瘤最大直徑,是否破裂出血,包膜是否完整,CA199,甲胎蛋白,術(shù)中手術(shù)出血量,術(shù)后是否行TACE等共18個變量,以期為合并MVI的單發(fā)腫瘤的臨床治療及預(yù)后評估提供理論依據(jù)。采用SPSS 19.0軟件進行分析,通過Kaplan-Meier法計算患者的生存率,Log-rank檢驗進行單因素分析,采用COX模型進行多因素分析,篩選出合并MVI單發(fā)肝癌患者預(yù)后相關(guān)影響因素。結(jié)果:隨訪至2016年12月31日。共有152例患者,男性132例,女性20例。患者年齡平均47.47±10.40歲,最大76歲,最小26歲。共有76例復發(fā),23例死亡。無瘤生存中位時間16個月,總生存中位時間57個月。1、2、3年無瘤生存時間分別為58.1%、38.8%、25.7%。1、2、3年累計生存率分別為93.3%、85.8%、82.0%。單因素分析結(jié)果顯示:性別,年齡,谷丙轉(zhuǎn)氨酶,白蛋白,總膽紅素,血小板,谷氨酰轉(zhuǎn)肽酶,乙肝表面抗原陽性與否,肝硬化與否,CA199,甲胎蛋白,術(shù)后是否行TACE與合并MVI的單發(fā)肝癌預(yù)后無明顯相關(guān)(P值0.05),腫瘤破裂出血,腫瘤直徑5cm及術(shù)中失血量500m L是影響患者無瘤生存的相關(guān)因素,而腫瘤包膜不完整,術(shù)前AST40U/L及PT≥14S是影響患者總生存的相關(guān)因素(P值0.05)。多因素分析結(jié)果顯示:術(shù)中失血500m L是影響患者無瘤生存的獨立預(yù)后因素,術(shù)前AST40U/L及PT≥14S是影響患者總生存的獨立預(yù)后因素。結(jié)論:對于合并MVI的單發(fā)肝癌患者,術(shù)中失血500m L是影響患者無瘤生存的獨立預(yù)后因素;術(shù)前AST40U/L及PT≥14S是影響總患者生存的獨立預(yù)后因素。
[Abstract]:Objective: to investigate the prognostic factors of patients with single hepatocellular carcinoma (HCC) complicated with microvascular invasion of MVI (Microvascular invasion MVI), and to provide theoretical basis for clinical treatment and prognosis evaluation of patients with MVI liver cancer. Methods: the data of patients undergoing radical resection of hepatocellular carcinoma from January 2012 to December 2014 in the Department of Hepatobiliary surgery, Cancer Hospital, Guangxi Medical University, were retrospectively analyzed. A total of 152 patients with MVI were selected and followed up. The factors influencing the prognosis of HCC with MVI were analyzed, including sex, age, glutamic oxaloacetic transaminase, and related factors, including: patient's sex, age, and aspartate aminotransferase. Alanine aminotransferase, albumin, total bilirubin, platelets, coagulation time, glutamyl transpeptidase, hepatitis B surface antigen positive or not, cirrhosis or not, maximum diameter of tumor, rupture or hemorrhage, intact capsule CA199, alpha-fetoprotein, In order to provide theoretical basis for clinical treatment and prognosis evaluation of single tumor with MVI, 18 variables, such as intraoperative bleeding volume, postoperative TACE and so on, could be provided. SPSS 19.0 software was used to analyze, the survival rate was calculated by Kaplan-Meier method and Log-rank test was used to carry out univariate analysis. Cox model was used to carry out multivariate analysis to screen the prognostic factors of patients with MVI single liver cancer. Results: all patients were followed up until December 31, 2016. There were 152 patients, 132 males and 20 females. The average age of the patients was 47.47 鹵10.40 years old, the oldest was 76 years old and the youngest was 26 years old. A total of 76 cases of recurrence and 23 cases of death. The median survival time of tumor-free was 16 months, the median survival time of total survival was 57 months. The mean survival time of 3 years was 58.1 and 38.825.7.1.The cumulative 3-year survival rate was 93.35.8 and 82.0, respectively. Univariate analysis showed: sex, age, alanine aminotransferase, albumin, total bilirubin, platelets, glutamyl transpeptidase, hepatitis B surface antigen positive or not, liver cirrhosis or not CA199, alpha-fetoprotein, There was no significant correlation between TACE and prognosis of HCC with MVI after operation (P = 0. 05). Tumor rupture and hemorrhage, tumor diameter 5cm and blood loss during operation were the related factors affecting the survival of patients without tumor, but the tumor capsule was incomplete. Preoperative AST 40 U / L and PT 鈮，

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