肝细胞癌自发性破裂出血行肝切除术的疗效及生存分析

王新伟; 王维娜; 张宗利

doi:10.3969/j.issn.1001-5256.2019.01.021

肝细胞癌自发性破裂出血行肝切除术的疗效及生存分析

DOI: 10.3969/j.issn.1001-5256.2019.01.021

1. 山东省日照市中医医院肝胆外科
2. 山东大学齐鲁医院肝胆外科

详细信息

中图分类号: R735.7
计量
- 文章访问数: 1670
- HTML全文浏览量: 27
- PDF下载量: 296
- 被引次数: 0
出版历程
- 出版日期: 2019-01-20

Surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy

Department of Hepatobiliary Surgery, Rizhao Municipal Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, China

摘要

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KaplanMeier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,...
- 癌,肝细胞 /
- 破裂,自发性 /
- 肝切除术 /
- 危险因素
Abstract:
Objective To investigate the surgical outcome and survival of patients with spontaneous rupture and bleeding of hepatocellular carcinoma after hepatectomy.Methods A 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.Results Of 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 were47.5%, 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,
- carcinoma, hepatocellular /
- rupture, spontaneous /
- hepatectomy /
- risk factors

HTML全文

参考文献(19)

[1]ZHU Q, LI J, YAN JJ, et al.Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma[J].World J Gastroenterol, 2012, 18 (48) :7302-7307.

[2]VERGARA V, MURATORE A, BOUZARI H, et al.Spontaneous rupture of hepatocelluar carcinoma:Surgical resection and longterm survival[J].Eur J Surg Oncol, 2000, 26 (8) :770-772.

[3]AOKI T, KOKUDO N, MATSUYAMA Y, et al.Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma:An analysis of 1160 cases from a nationwide survey[J].Ann Surg, 2014, 259 (3) :532-542.

[4]QI HL, QIAN CW, XIAO YS, et al.Diagnosis and treatment for spontaneous rupture of hepatocellular carcinoma[J].J Abdominal Surg, 2015, 28 (5) :371-374. (in Chinese) 齐浩龙, 钱崇崴, 肖玉沙, 等.肝细胞肝癌自发破裂出血的诊治与研究进展[J].腹部外科, 2015, 28 (5) :371-374.

[5]National Health and Family Planning Commission of the People’s Republic of China.Diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J].J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431.

[6]ZHANG H, LUO SQ, WU ZJ.Diagnosis and treatment for spontaneous rupture of hepatocellular carcinoma[J].Chin J Bases Clin Gen Surg, 2011, 18 (12) :1338-1343. (in Chinese) 张华, 罗诗樵, 吴忠均.肝癌破裂出血的诊断和治疗[J].中国普外基础与临床杂志, 2011, 18 (12) :1338-1343.

[7]GAO W, LI T, ZHAO W, et al.Risk factors and outcomes of different treatment for spontaneous rupture of hepatoceulllar carcinoma[J].Clin J Curr Adv Gen Surg, 2016, 19 (7) :527-530. (in Chinese) 高伟, 李涛, 赵威, 等.原发性肝细胞性肝癌自发破裂出血危险因素及不同治疗方法预后分析[J].中国现代普通外科进展, 2016, 19 (7) :527-530.

[8]YOU MX, YU XX, WU K, et al.Analysis of risk factors for spontaneous rupture of hepatocellular carcinoma[J].Chin JOncol, 2013, 35 (3) :217-220. (in Chinese) 游梦星, 虞希祥, 吴宽, 等.原发性肝癌自发性破裂出血的危险因素分析[J].中华肿瘤杂志, 2013, 35 (3) :217-220.

[9] WANG ZM, LU XS, FU Q.Hepatectomy for spontaneous rupture of hepatocellular carcinoma without portal triad clamping[J].Oncology Letters, 2017, 14 (4) :3997-4004. (in Chinese) 王志明, 卢新生, 付秋.不夹闭门脉的肝切除术治疗肝细胞癌自发性破裂[J].肿瘤学快报, 2017, 14 (4) :3997-4004.

[10]SHEN SQ, YANG YF, GE NJ, et al.Evaluation of interventional and surgical treatments for the hemorrhage of ruptured hepatocellular carcinoma[J].J Intervent Radiol, 2010, 19 (7) :544-546. (in Chinese) 申淑群, 杨业发, 葛乃建, 等.肝癌破裂出血的介入与外科手术疗效评价[J].介入放射学杂志, 2010, 19 (7) :544-546.

[11]ZHONG F, CHENG XS, WANG JZ, et al.Analysis of shortand long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer[J/CD].Chin J Hepatic Surg:Electronic Edition, 2016, 5 (2) :95-100. (in Chinese) 钟锋, 程新生, 王金重, 等.原发性肝癌自发破裂出血患者近期及远期预后因素分析[J/CD].中华肝脏外科手术学电子杂志, 2016, 5 (2) :95-100.

[12]CHU ZQ, WU XW, YANG HQ, et al.Survival rate analysis and influence factors of primary liver cancer surgery[J].J Pract Med, 2013, 29 (5) :787-789. (in Chinese) 褚志强, 吴向未, 杨宏强, 等.原发性肝癌手术治疗的生存率分析及影响因素研究[J].实用医学杂志, 2013, 29 (5) :787-789.

[13]BATTULA N, MADANUR M, PRIEST O, et al.Spontaneous rupture of hepatocellular carcinoma:A Western experience[J].Am J Surg, 2009, 197 (2) :164-167.

[14]OU DP, YANG LY, YANG H, et al.Prognostic analysis of emergency hepatectomy for spontaneous rupture and hemorrhage of hepatocellular carcinoma[J].Chin J Gen Surg, 2017, 26 (1) :25-30. (in Chinese) 欧迪鹏, 杨连粤, 杨浩, 等.急诊肝切除治疗原发性肝癌破裂的预后分析[J].中国普通外科杂志, 2017, 26 (1) :25-30.

[15]LI XC, WANG K, LI CX, et al.Clinical efficacy and prognostic factors analysis of radical hepatectomy of hepatocellular carcinoma in 760 patients[J].Chin J Dig Surg, 2017, 16 (4) :398-404. (in Chinese) 李相成, 王科, 李长贤, 等.760例肝细胞癌根治术的临床疗效及预后因素分析[J].中华消化外科杂志, 2017, 16 (4) :398-404.

[16]JIN Y, LI JT.Research progress in related clinical factors and molecular biomarkers for microvascular invasion in hepatocellular carcinoma[J].J Clin Hepatol, 2013, 29 (7) :550-553. (in Chinese) 金赟, 李江涛.肝癌细胞侵犯微血管的临床相关因素及分子标志物的研究进展[J].临床肝胆病杂志, 2013, 29 (7) :550-553.

[17]YAMASHITA S, SHETH RA, NIEKAMP AS, et al.Comprehensive complication index predicts cancer-specific survival after resection of colorectal metastases independent of RAS mutational status[J].Ann Surg, 2017, 266 (6) :1045-1054.

[18]TOKUNAGA M, TANIZAWA Y, BANDO E, et al.Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer[J].Ann Surg Oncol, 2013, 20 (5) :1575-1583.

[19]MARGONIS GA, SASAKI K, ANDREATOS N, et al.Prognostic impact of complications after resection of early stage hepatocellular carcinoma[J].J Surg Oncol, 2017, 115 (7) :791-804.

施引文献

资源附件(0)

访问统计