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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (02) : 142 -147. doi: 10.3877/cma.j.issn.2095-3232.2020.02.011

所属专题： 文献；

临床研究

符合米兰标准的中央型肝癌手术切除疗效分析
吴若林1, 方翊天1, 赵红川1,†(), 黄帆1, 王国斌1, 余孝俊1, 侯刘进1, 耿小平1, 叶征辉1, 张兴华1   
  1. 1. 230022　合肥，安徽医科大学第一附属医院器官移植中心　肝胆胰二病区
  • 收稿日期:2019-12-06 出版日期:2020-04-10
  • 通信作者: 赵红川
  • 基金资助:
    安徽医科大学第一附属医院院内青年基金(2019kj12)

Analysis of clinical efficacy of surgical resection of central hepatocellular carcinoma conforming to Milan criteria

Ruolin Wu1, Yitian Fang1, Hongchuan Zhao1,†(), Fan Huang1, Guobin Wang1, Xiaojun Yu1, Liujin Hou1, Xiaoping Geng1, Zhenghui Ye1, Xinghua Zhang1   

  1. 1. Organ Transplantation Center, Department of Hepatobiliopancreatic Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2019-12-06 Published:2020-04-10
  • Corresponding author: Hongchuan Zhao
  • About author:
    Corresponding author: Zhao Hongchuan, Email:
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吴若林, 方翊天, 赵红川, 黄帆, 王国斌, 余孝俊, 侯刘进, 耿小平, 叶征辉, 张兴华. 符合米兰标准的中央型肝癌手术切除疗效分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(02): 142-147.

Ruolin Wu, Yitian Fang, Hongchuan Zhao, Fan Huang, Guobin Wang, Xiaojun Yu, Liujin Hou, Xiaoping Geng, Zhenghui Ye, Xinghua Zhang. Analysis of clinical efficacy of surgical resection of central hepatocellular carcinoma conforming to Milan criteria[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(02): 142-147.

目的

探讨符合米兰标准的中央型肝细胞癌（肝癌）外科手术切除的疗效。

方法

回顾性分析2010年1月至2015年6月在安徽医科大学第一附属医院行肝切除术的76例肝癌患者临床资料。其中男62例，女14例；平均年龄（57±11）岁。患者均签署知情同意书，符合医学伦理学规定。根据肿瘤位置分为中央型组（22例）和周围型组（54例）。分析比较两组患者术中、术后情况及生存情况。两组肿瘤复发率的比较采用χ2检验。采用Kaplan-Meier法绘制生存曲线，生存分析采用Log-rank检验。

结果

中央型组患者肿瘤复发率为59%（13/22），其中肝内复发11例，肺部转移1例，脑转移1例；周围型组肿瘤复发率为46%（25/54），其中肝内复发22例，肺部转移2例，纵膈转移1例，骨转移1例；两组肿瘤复发率比较差异无统计学意义（χ2=1.024，P>0.05）。中央型组患者术后1、3、5年无瘤生存率分别为68.2%、45.5%、40.9%，周围型组相应为79.5%、67.8%、56.9%，两组无瘤生存率差异无统计学意义（χ2=2.242，P>0.05）。中央型组术后1、3、5年总体生存率分别为86.4%、68.2%、50.9%，周围型组相应为96.3%、83.3%、71.6%，两组总体生存率差异无统计学意义（χ2=1.276，P>0.05）。

结论

符合米兰标准的中央型肝癌接受肝切除术能取得与周围型肝癌相当的远期生存疗效。

关键词: 癌，肝细胞, 米兰标准, 肝切除术, 肿瘤转移
Objective

To evaluate the clinical efficacy of surgical resection of central hepatocellular carcinoma (HCC) conforming to the Milan criteria.

Methods

Clinical data of 76 HCC patients who underwent hepatectomy in the First Affiliated Hospital of Anhui Medical University from January 2010 to June 2015 were retrospectively analyzed. Among them, 62 patients were male and 14 female,aged (57±11) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the tumor location, all patients were divided into central type group (n=22) and peripheral type group (n=54). Intraoperative and postoperative conditions and survival were statistically compared between two groups. The recurrence rate between two groups was statistically compared by Chi-square test. The survival curve was delineated by Kaplan-Meier method. Survival analysis was performed by Log-rank test.

Results

The recurrence rate in central type group was 59%(13/22), including 11 cases of intrahepatic recurrence, 1 case of lung metastasis and 1 case of brain metastasis. The recurrence rate in peripheral type group was 46%(25/54), including 22 cases of intrahepatic recurrence, 2 cases of lung metastasis, 1 case of mediastinal metastasis and 1 case of bone metastasis. No significant difference was observed between two groups in tumor recurrence rate (χ2=1.024, P>0.05). The 1-, 3-, and 5-year disease-free survival rates in central type group were 68.2%, 45.5%, and 40.9%, which did not significantly differ from 79.5%, 67.8%, and 56.9% in peripheral type group (χ2=2.242, P>0.05). The 1-, 3-, and 5-year overall survival rates in central type group were 86.4%, 68.2%, and 50.9%, which did not significantly differ from 96.3%, 83.3%, and 71.6% in peripheral type group (χ2=1.276, P>0.05).

Conclusions

Patients with central HCC conforming to the Milan criteria can obtain similar long-term survival as the patients with peripheral HCC.

Key words: Carcinoma, hepatocellular, Milan criteria, Hepatectomy, Neoplasm metastasis
表1 中央型组与周围型组肝癌患者术前一般资料比较
组别 例数 年龄（岁，±s） 性别（例） 乙肝病史（例） 上腹部手术史（例） AFP（μg/L，例） 肝硬化（例） 肿瘤直径（cm，±s）
男 女 无 有 无 有 <400 ≥400 无 有
中央型组 22 60±10 18 4 9 13 15 7 12 10 8 14 3.7±1.0
周围型组 54 55±11 44 10 12 42 44 10 38 16 23 31 3.6±1.1
统计值 ? t=2.011 χ2=0.000 χ2=2.730 χ2=1.592 χ2=1.793 χ2=0.251 t=0.344
P值 ? 0.048 1.000 0.156 0.207 0.187 0.616 0.732
表2 中央型组与周围型组肝癌患者术中及术后情况比较
组别 例数 手术时间（h，±s） 输红细胞（例） 输血浆（例） 第一肝门阻断（例） 住院时间（d，±s） 并发症（例）
无 有 无 有 无 有 无 有
中央型组 22 2.7±0.7 20 2 21 1 8 14 16±5 14 8
周围型组 54 2.5±0.9 48 6 45 9 32 22 16±6 42 12
统计值 ? t=0.866 χ2=0.000 χ2=1.089 χ2=3.287 t=0.205 χ2=1.612
P值 ? 0.389 1.000 0.297 0.070 0.838 0.204
图1 中央型与周围型肝癌患者无瘤生存和总体生存Kaplan-Meier曲线
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