小肝癌患者术后肝内早期复发的生存因素分析

目的通过对小肝癌患者术后肝内早期复发的治疗,研究对患者生存因素的影响。方法回顾2009～2011年收治的小肝癌术后肝内早期复发48例患者的临床资料,年龄37～72岁,平均(52.80±12.22)岁,男32例,女16例。复发性小肝癌患者中符合手术指征者予以再次手术治疗,本组患者全部符合,其中运用左半肝切除术8例,肝部分切除或肝段切除术治疗38例,姑息切除术2例。其中有26例术中留置门静脉管,术后定期局部化疗。结果通过不同手术方式后3年对比,运用左半肝切除术治疗后患者,复发率、转移率(12.50%、12.50%)比肝部分切除(26.32%、15.79%)和姑息切除术(100.00%、100.00%)明显降低,生存率(75.00%)比(57.89%、0.00%)明显升高,差异显著具有统计学意义(P<0.05)。而且说明不同手术方式选择会对治疗后生存质量产生影响。两年内复发和两年后复发情况对比,差异不显著,无统计学意义。复发后不同大小的复发灶对患者生存率和复发转移率影响明显,直径≤5cm患者34例,3年共转移3(8.82%)例,3年生存率91.18%;直径>5cm患者14例,3年共复发转移7(50.00%)例,3年生存率为71.43%,直径≤5cm患者生存率、转移率与直径>5cm患者对比,差异显著具有统计学意义(P<0.05)。结论小肝癌患者术后肝内早期复发,对生存因素主要为结节大小,结节直径越小,切除范围大,对患者预后效果就越好,反之则越差。

Objective To explore the effects to survival factors through intrahepatic recurrence in early stage treatment after the operation of small hepatocellular carcinoma patients.Methods To review the 48 small hepatocellular carcinoma patients after operation with early recurrence of liver in our hospital,from 2009 to 2011.They are aging from 37～72（52.80±12.22）years.And 32 cases are male,16 cases are female.Those recurrent small hepatocellular carcinoma patients fitted operation indication were given operation treatment again.All the patients in this group are fitted,in which 8 cases had left liver resection,38 cases had partial liver resection or liver segment resection,2 cases had palliative resection.And 26 of them lie portal vein tube in the operation,and had regular postoperative chemotherapy after the operation.Results Through different operation mode after 3 year,The recurrence rate and metastasis rate（12.50%,12.50%） reduced significantly than had partial liver resection（26.32%,15.79%） and had palliative resection（100.00%,100.00%）,survival rate（75.00%） rising significantly than had partial liver resection and had palliative resection（57.89%,0.00%）.Also illustrate the different operation methods on survival after treatment of quality influence.Within two years of relapse and recurrence two years after comparison,the differences are not significant,no statistical significance.Recurrence after different recurrence on survival rate and recurrence rate was less than 5 cm in diameter,34 patients,3 years a total of 3（8.82%） cases of metastasis,3 year survival rate was 91.18%;greater than 5 cm in diameter,14 patients,3 years a total of 7（50%） cases of recurrence and metastasis,3 year survival rate71.43%,diameter≤5cm,transfer rate and the survival rate of patients with5cm in diameter,in contrast,significant difference,with statistical significance（P〈0.05）.Conclusion Small hepatocellular carcinoma patients with postoperative liver early recurrence on survival factors for nodule size,nodules with smaller diameter,resection on the prognosis of patients with large range,better,or worse.