肝切除手术相关因素对肝细胞癌预后的影响

Prognostic value of surgical operation-related factors in patients with hepatocellular carcinoma

目的分析影响肝细胞癌(HCC)患者预后的手术相关因素。方法1991年1月～2002年6月实施根治性肝切除、随访资料和临床资料完整的HCC患者234例,回顾性分析医源性肝癌被膜破裂、术中出血量、输血量、手术持续时间、手术大小程度、肝门阻断次数和术后并发症(胆漏、切口感染、胸腔积液)等手术相关因素对患者长期存活的影响。生存时间比较采用Log-rank检验各因素间的相关性采用双变量相关分析。结果医源性肝癌被膜破裂、术中出血量、输血量和手术持续时间可影响HCC预后(P<0·05)。输血量与手术大小程度呈正相关(P<0·05),但出血量与后者无明显相关性(P>0·05)。结论减少出血和输血量、缩短手术时间、避免肝癌被膜破裂是改善HCC预后的重要举措。

Objective To evaluate the prognostic value of surgical operation-related factors in patients with hepatocellular carcinoma （HCC）. Methods A retrospective study was carried out by analyzing the data of 234 patients with HCC undergoing hepatic resection （214 men and 20 women） from January 1991 to June 2002 at Southwest Hospital, Third Milhary Medical University. Survival rates were ana lyzed using the actuarial life-table method, Kaplan-Meier curve and log-rank tests were employed to compare the survival rates observed in those patients with surgical operation-related factors （e. g. extent of surgery, time of operation, portal blockage, complications, iatrogenic tumour rupture, intraoperative blood loss and amount of blood transfusion）, and Bivariate correlation analysis was used to examine the as sociations of these surgical operation-related factors. Results Kaplan-Meier curve and log-rank analysis revealed that iatrogenic tumour rupture, intraoperative blood loss and amount of blood transfusion, and the operation time were significant predictors for the patients with HCC after hepatic resection （P〈0. 05）. The extent of surgery, portal blockage and complications （e. g. biliary leakage, incision infection and pleural effusion etc. ） were not significant prognostic factors （P〉0. 05）. There was no correlation between the extent of surgery and intraoperative blood loss, but a close correlation was found between amount of intraoperative blood transfusion and the extent of surgery. Conclusion The hepatic surgery directly affects the long-term survival of patients with HCC after hepatic resection, and may improve the patients＇ prognosis if amount of intraoperative blood transfusion and blood loss lessened, the operation time shortened and iatrogenic tumour rupture avoided. Some extensive liver resection may mislead the surgeons to ignore the principles of blood transfusion, which can adversely affect the prognosis of HCC after hepatic resection.