巴德-基亚里综合征合并肝硬化肝细胞癌的诊治策略:42例分析

Diagnosis and treatment strategy of Budd-Chiari syndrome complicated with liver cirrhosis and hepatocellular carcinoma:an analysis of 42 cases

目的:探讨巴德-基亚里综合征(Budd-Chiari syndrome,B-CS)合并肝硬化肝细胞癌(hepatocellular carcinoma,HCC)患者的预后影响因素及诊治策略。方法:回顾性分析2014年1月—2020年12月被郑州大学第一附属医院肝胆胰外科收治的42例B-CS合并HCC患者的临床资料,分析患者的临床特征与诊断HCC前是否曾行B-CS治疗的关系。采用Kaplan-Meier法绘制生存曲线,并用COX回归模型分析影响B-CS合并HCC患者预后的危险因素。结果:42例B-CS合并HCC患者均存在肝硬化,中位生存时间为28个月,1、3和5年总生存率分别为76.2%、50.0%和42.9%。诊断HCC前未曾行B-CS治疗的患者的最大肿瘤直径、肿瘤多发比例及血清总胆红素水平均高于既往曾行B-CS治疗的患者(P<0.05)。血清白蛋白水平(风险比:0.866,95%置信区间:0.771~0.972,P=0.015)、诊断HCC前未曾行B-CS治疗(风险比:2.796,95%置信区间:1.020~7.666,P=0.046)是B-CS合并HCC患者预后的独立危险因素。结论:B-CS合并HCC患者的预后相对较好,血清白蛋白水平以及诊断HCC前未曾行B-CS治疗是B-CS合并HCC患者预后的独立危险因素。

Objective:To investigate the diagnosis and treatment strategies as well as prognostic factors of Budd-Chiari syndrome(B-CS)patients complicated with liver cirrhosis and hepatocellular carcinoma(HCC).Methods:Clinical data of 42 B-CS patients complicated with HCC admitted to Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020 were retrospectively analyzed,and the association between the clinical characteristics of patients and whether they had undergone B-CS treatment or not before HCC diagnosis was analyzed.Kaplan-Meier method was used to plot the survival curve of the patients.COX regression model was used to analyze the risk factors affecting the prognosis of B-CS patients complicated with HCC.Results:All 42 B-CS patients complicated with HCC had liver cirrhosis,their median survival time was 28 months,and the 1-,3-and 5-year survival rates were 76.2%,50.0%and 42.9%,respectively.The maximum tumor diameter,multiple tumor ratio and total bilirubin level in patients who had not received B-CS treatment before HCC diagnosis were higher than those in patients who had.Serum albumin level(hazard ratio:0.866,95%confidence interval:0.771-0.972,P=0.015)and not receiving B-CS treatment before HCC diagnosis(hazard ratio:2.796,95%confidence interval:1.020-7.666,P=0.046)were independent risk factors for the prognosis of B-CS patients complicated with HCC.Conclusion:The prognosis of B-CS patients complicated with HCC is relatively good.Serum albumin level and not receiving B-CS treatment before HCC diagnosis are independent risk factors for the prognosis of B-CS patients complicated with HCC.