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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 ›› 2021, Vol. 10 ›› Issue (06) : 579 -583. doi: 10.3877/cma.j.issn.2095-3232.2021.06.010

临床研究

肝癌破裂出血肝切除和介入治疗疗效比较及肝切除术后肝癌复发影响因素
郑文能1, 林楚芳2, 林庆斌1, 林文斌1,†()   
  1. 1. 363000　福建省漳州市，解放军联勤保障部队第909医院急诊科
    2. 363000　福建省漳州市，解放军联勤保障部队第909医院消化内科
  • 收稿日期:2021-07-19 出版日期:2021-09-23
  • 通信作者: 林文斌
  • 基金资助:
    中国人民解放军联勤保障部队第909医院青年苗圃基金(18Y030)

Comparison of efficacy between hepatectomy and interventional therapy for liver cancer rupture and bleeding and influencing factors of tumor recurrence after hepatectomy

Wenneng Zheng1, Chufang Lin2, Qingbin Lin1, Wenbin Lin1,†()   

  1. 1. Emergency Department, No.909 Hospital of the PLA Joint Logistics Support Force, Zhangzhou 363000, China
    2. Department of Gastroenterology, No.909 Hospital of the PLA Joint Logistics Support Force, Zhangzhou 363000, China
  • Received:2021-07-19 Published:2021-09-23
  • Corresponding author: Wenbin Lin
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郑文能, 林楚芳, 林庆斌, 林文斌. 肝癌破裂出血肝切除和介入治疗疗效比较及肝切除术后肝癌复发影响因素[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 579-583.

Wenneng Zheng, Chufang Lin, Qingbin Lin, Wenbin Lin. Comparison of efficacy between hepatectomy and interventional therapy for liver cancer rupture and bleeding and influencing factors of tumor recurrence after hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(06): 579-583.

目的

比较肝切除和介入治疗肝癌破裂出血的疗效，并探讨肝切除术后肿瘤复发的影响因素。

方法

回顾性分析2006年1月1日至2015年12月1日解放军联勤保障部队第909医院收治的92例肝癌破裂出血患者临床资料。其中男59例，女33例；年龄29~74岁，中位年龄46岁。患者均签署知情同意书，符合医学伦理学规定。根据治疗方法不同分为肝切除组（52例）和介入组（40例），比较两组患者术后生存和肿瘤复发情况。生存分析采用Kaplan-Meier法和Log-rank检验。等待手术时间与患者生存、复发时间的相关性分析采用线性相关分析。多因素分析采用Cox比例风险回归模型。

结果

肝切除组术后1、3、5年累积生存率分别为90.38%、55.77%、13.46%，介入组相应为90.00%、25.00%、10.00%，肝切除组术后生存优于介入组（χ2=4.334，P<0.05）。肝切除组术后1、3年肿瘤复发率为21.15%、78.84%，介入组相应为27.50%、85.00%，肝切除组术后肿瘤复发率明显低于介入组（χ2=3.899，P<0.05）。等待手术时间与患者术后生存、肿瘤复发时间成负相关（r=-0.720，-0.784；P<0.05）。多因素分析结果显示，等待手术时间、肿瘤分化、微血管侵犯是肝癌破裂出血患者术后肿瘤复发的独立影响因素（HR=0.937，0.113，12.934；P<0.05）。

结论

肝癌破裂出血患者采用手术切除效果优于介入治疗，等待手术时间、肿瘤分化、微血管侵犯是肝切除患者术后肿瘤复发的独立影响因素，尽早手术切除能降低肿瘤复发率，提高生存率。

关键词: 肝肿瘤, 破裂, 肝切除术, 复发, 肿瘤转移, 危险因素
Objective

To compare the clinical efficacy of hepatectomy and interventional therapy for liver cancer rupture and bleeding, and to explore the influencing factors of tumor recurrence after hepatectomy.

Methods

Clinical data of 92 patients with liver cancer rupture and bleeding admitted to No.909 Hospital of the PLA Joint Logistics Support Force from January 1, 2006 to December 1, 2015 were retrospectively analyzed. Among them, 59 patients were male and 33 female, aged from 29 to 74 years, with a median age of 46 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different treatment methods, all patients were divided into the hepatectomy (n=52) and interventional therapy groups (n=40). Postoperative survival and tumor recurrence were compared between two groups. Survival analysis was performed by Kaplan-Meier method andLog-rank test. The correlation analysis of waiting time for surgery with survival time, recurrence time was conducted by using linear correlation analysis. Multivariate analysis was carried out by Cox proportional hazard regression model.

Results

In the hepatectomy group, the 1-, 3-, 5-year cumulative survival rates were 90.38%, 55.77%, 13.46%, and 90.00%, 25.00%, 10.00% in the interventional group. The postoperative survival in the hepatectomy group was better than that in the interventional group (χ2=4.334, P<0.05). In the hepatectomy group, the 1-, 3-year tumor recurrence rates were 21.15%, 78.84%, and were 27.50%, 85.00% in the interventional group. The tumor recurrence rate in the hepatectomy group was significantly lower than that in the interventional group (χ2=3.899, P<0.05). The waiting time for surgery was negatively correlated with the postoperative survival and tumor recurrence time (r=-0.720, -0.784; P<0.05). Multivariate analysis demonstrated that waiting time for surgery, tumor differentiation and microvascular invasion were the independent influencing factors for the postoperative tumor recurrence in patients with liver cancer rupture and bleeding (HR=0.937, 0.113, 12.934; P<0.05).

Conclusions

Hepatectomy yields better efficacy than interventional therapy for patients with rupture and bleeding of liver cancer. Waiting time for surgery, tumor differentiation and microvascular invasion are the independent influencing factors of postoperative tumor recurrence. Early surgical resection can lower the tumor recurrence rate and increase the survival rate.

Key words: Liver neoplasms, Rupture, Hepatectomy, Recurrence, Neoplasm metastasis, Risk factors
表1 肝切除组和介入组肝癌破裂出血患者一般资料比较（例）
分组 例数 年龄 性别 肿瘤数目 肿瘤直径 HBsAg AFP
<50岁 ≥50岁 男 女 单发 多发 <3 cm ≥3 cm 阴性 阳性 <400 μg/L ≥400 μg/L
肝切除组 52 34 18 36 16 31 21 24 28 10 42 27 25
介入组 40 26 14 29 11 25 15 22 18 9 31 18 22
χ2值   1.090 0.117 0.079 1.165 0.147 0.434
P值   0.296 0.733 0.779 0.280 0.701 0.510
图1 肝切除组和介入组肝癌破裂出血患者术后生存和肿瘤复发Kaplan-Meier曲线
图2 肝癌破裂出血患者等待手术时间与术后生存、肿瘤复发时间的关系
表2 肝癌破裂出血患者肝切除术后肿瘤复发的Cox多因素分析
分组 b SE Wald χ2 HR 95%CI P值
性别男性 -1.054 1.058 0.993 0.349 0.044~2.771 0.319
等待手术时间<12 h -0.065 0.031 4.280 0.937 0.881~0.997 0.039
肿瘤高分化 -2.177 0.891 5.970 0.113 0.020~0.650 0.015
5-FU灌洗 1.706 0.997 2.925 5.505 0.779~3.884 0.087
HBsAg阳性 2.175 1.300 2.799 8.809 0.689~12.523 0.094
微血管侵犯 2.560 1.204 4.521 12.934 1.222~6.922 0.033
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