67例肝细胞肝癌合并重度肝硬化的手术疗效分析

Surgical Treatment for Hepatocellular Carcinoma Patients with Severe Cirrhosis——A Report of 67 Cases

背景与目的:肝细胞肝癌(下称肝癌)合并重度肝硬化,由于肝储备功能差,手术风险明显增高。本研究探讨肝癌合并重度肝硬化的手术安全性、疗效和预后影响因素。方法:回顾性分析我院1998年至2003年经手术切除的67例肝癌合并重度肝硬化的患者资料,根据随访结果计算生存率并作单因素和多因素分析。结果:3例围手术期死亡。术后1、3、5年累积生存率分别为62.6%、46.7%、19.9%。单因素分析结果表明预后影响因素为术前Child-Pugh分级、吲哚靛青绿15min储备率(ICGR15)、血小板计数、肿瘤大小、肿瘤数目和是否根治性切除;多因素分析得出影响疗效的独立预后因素为术前Child-Pugh分级和是否根治性切除。结论:正确的术前肝储备功能评估,可增加手术切除的安全性,使部分合并重度肝硬化的肝癌患者获得手术根治的机会。术后辅助治疗有助提高患者生存率。

BACKGROUND ＆ OBJECTIVE： Weak liver function reserve of hepatocellular carcinoma （HCC） patients with severe cirrhosis lead to high risk of operation. This study was to explore the safety and effects of hepatectomy for HCC patients with severe cirrhosis, and analyze prognostic factors. METHODS. Clinical data of 67 HCC patients with severe cirrhosis, who underwent hepatectomy from 1998 to 2003, were reviewed. The patients were followed up till March 2006, The prognostic factors were studied by univariate and multivariate analysis. RESULTS： Three patients died after operation. The 1-, 3-, and 5-year cumulative survival rates were 62.6%, 46.7%, and 19.9%, respectively. Univariate analysis showed that Child-Pugh classification, indocyanine green retention rate at 15 min （ICGR15）, platelet count, tumor size, number of tumors, and radical resection were significant prognostic factors. Cox multivariate proportional hazard model indicated that Child-Pugh classification and radical resection were independent prognostic factors, CONCLUSION： Correct preoperative assessment of liver function reserve can increase the safety of radical surgical resection for HCC patients with severe cirrhosis.