原发性肝癌合并肝源性糖尿病的治疗方法及预后相关因素分析

Therapy and prognostic features of primary hepatocellular carcinoma with hepatogenous diabetes

目的探讨原发性肝癌合并肝源性糖尿病(PHCHD)的治疗方法,并分析其预后影响因素。方法 68例PHCHD患者均行手术切除治疗,其中肝大部切除19例,半肝切除13例,次半肝切除36例;术后单纯皮下注射胰岛素46例,胰岛素皮下注射加阿卡波糖口服22例。采用Kaplan-Meier法分析患者的临床资料与生存时间的关系,采用COX多因素回归分析PHCHD预后相关因素。结果本组中位生存期32个月,1、3、5 a生存率为76.13%、47.36%、36.12%。血清HCVAb、Child-Pugh分级、TNM分期、肝硬化、门脉瘤栓、血管侵犯与患者生存时间有关(P均<0.05);肝硬化、血管侵犯、门脉瘤栓与患者的预后有关(P均<0.05)。结论手术切除和胰岛素皮下注射是治疗PHCHD的有效方法;肝硬化、血管侵犯、门脉瘤栓是影响PHCHD患者预后的独立危险因素。

Objective To explore the therapeutic strategies and prognosis factors of primary hepatocellular carcinoma with hepatogenous diabetes（PHCHD）.Method The clinical pathological data of 68 patients with PHCHD treated with hepatectomy were analized retrospectively.Results All 68 patients underwent surgical tumor resection.Anatomical resection included segmentectomy 19 cases,hemi-hepatectomy 13 cases and sub-segmentectomy 36 cases.Single insulin treatment group was 46 cases,the acarbose and insulin treatment gtoup was 22 cases.Median survival period of the PHCHD was 32 months.1,3 and 5 years survival rates were 76.13%,47.36%,36.12%.The Kaplan-Meier method showed that serum HCVAb,Child-Pugh classification,TNM staging,liver cirrhosis,vascular invasion and portal vein embolus were related to survival.Cox regression analysis showed that liver cirrhosis,portal vein embolus and vascular invasion were independent risk factors for overall survival.Conclusions The surgery and insulin treatment are most effective modality for the patients with PHCHD.Liver cirrhosis,portal vein embolus and vascular invasion are independent risk factors for prognosis of PHCHD.