术中经大网膜静脉注入丝裂霉素对肝细胞肝癌切除术后预后影响的分析

Effect of mitomycin C injection via great omentum vein on prognosis of hepatocellular carcinoma resection

目的:探讨肝细胞肝癌(HCC)肝切除治疗术中经大网膜静脉注射丝裂霉素(MMC)对预防术后肿瘤复发的价值。方法:回顾分析2000-01-2004-06我院收治的73例HCC行肝切除术患者的临床资料。用药组38例患者术中经大网膜静脉注射10 mg MMC,对照组35例患者未行任何化疗药物注射,随访术后复发情况,并作统计学分析。结果:两组患者的相关临床资料差异无统计学意义,P>0.05。多因素分析提示,术后复发与肿瘤数量及大小有关,危险系数分别为1.877(P=0.001 0)及1.391(P=0.029 4),MMC用药与否对术后复发无明显影响。用药组与对照组术后复发时间用药组和对照组差异无统计学意义,中位无瘤生存时间分别为术后10个月及8个月(P=0.125 3)。用药组和对照组术后1、2、3和5年复发率分别为65.79%6、8.57%(P=0.800 4),81.58%、94.29%(P=0.099 0),89.47%、97.14%(P=0.195 0)和92.11%、97.14%(P=0.344 7)。结论:肝切除术中经大网膜静脉注射MMC(10 mg)对预防HCC术后肿瘤复发可能没有确切价值,但仍有待进一步的前瞻性研究证实。

OBJECTIVE：To estimate the preventive effect of mitomycin C（MMC） injection via great omentum vein during resection of hepatocellular carcinoma（HCC） against the recurrence of HCC.METHODS：The clinical data of 73 HCC patients,who were treated in our hospital form Jan.2000 to Jun.2004,were retrospectively analyzed.Thirty-eight patients were injected with 10 mg MMC via great omentum vein during operation;thirty-five patients who received no chemotherapeutic agents were taken as controls.The recurrence of the disease was followed up and was statistically analyzed.RESULTS：Patients in the 2 groups were matchable（P0.05）.Multivariate analysis showed that the recurrence was related to the number and diameter of the tumors,with the hazard ratios being 1.877（P=0.001 0） and 1.391（P=0.029 4）,respectively.Injection of MMC had no influence on the recurrence.There was no significant difference in the time of disease-free survival（DFS） between the 2 groups,with the median time of DFS of MMC injection group being 10 months and of con trol group being 8 months after the first operation（P=0.125 3）.The recurrence rates in the MMC group and control group were 65.79% vs 68.57%（P=0.800 4） 1 year after operation,81.58% vs 94.29%（P=0.099 0） 2 years after operation,89.47% vs 97.14%（P=0.195 0） 3 years after operation and 92.11% vs 97.14%（P=0.344 7） 5 years after operation.CONCLUSION：Injection of 10 mg MMC via great omentum vein during resection of HCC may have no definite effect on the recurrence of HCC;however,perspective study is needed to verify this finding.