手术切缘对伴门脉癌栓肝癌患者术后复发与生存的影响

The Effect of cutting edge on Long-term Prognosis and survial of Hepatocellular Carcinoma Patients with PVTT After Resection Surgery

目的比较不同的手术切缘对伴有门脉癌栓的肝癌患者术后复发及生存的影响, 为肝癌患者手术治疗选择合理切缘提供参考.方法：回顾性分析本科收治的367例肝癌患者,分为两组, 一组为伴有门脉癌栓的肝癌患者,另外一组为不伴有门脉癌栓的肝癌患者.应用Kaplan-Meier法进行生存分析,用Log rank检验分别比较两组的无瘤生存期和总生存期.结果：比较两组研究对象发现组间肝脏微转移灶发生率存在显著差异（P〈0.0001）.研究两组研究对象中手术切缘距肿瘤在0.5～1.5 cm的患者的切缘阳性率,伴门脉癌栓（91例）和不伴有门脉癌栓（276例）两组肝癌患者分别为35.3%和14.3%,肝癌患者伴有门脉癌栓是发生肿瘤微转移的一个可能的危险因素.在伴有门脉癌栓的患者中以距离肿瘤1cm的手术切缘为临界值,切缘〉1cm组患者平均无瘤生存期为35.5个月, 平均总生存期为42.0个月;≤1cm切缘组患者平均无瘤生存期为28.8 个月, 平均总生存期为37.5个月, 两组总生存期（t=4.266, P =0.031）比较, 差异均有统计学意义.结论：伴有门脉癌栓的肝癌患者手术切缘离肿瘤远可以显著降低术后复发和死亡风险.

Objective We investigated the recurrence and survial of HCC patients with PVTT after resection surgery with different cutting edge and aimed to offer advice about optimal cutting edge during resection surgery. Methods： We divided 367 HCC patients into two groups. One group is HCC patients with PVTT. The other patients are in the second group. Survival analysis was performed using the Kaplan-Meier methods and compared using the log-rank test. Result： The recurrence of intrahepatic micrometastatic lesion is significant difference between two group （P〈0.0001）. Then selecting some cases whose cutting edge is 0.5-1.5cm to be observed their tumor margin weather be invaded or not. The rate of positive tumor margin is 35.35% and 14.3%, respectively. In the group of HCC patients with PVTT, The overall survival time of patients in wide-margin group （cutting edge〉1cm） and narrow-margin group （cutting edge≤1cm） were 45 months and 38 months, respectively. The tumor-free survival time of these two groups of patients w ere 36.8 months and 27.6 months, respectively. Patients in wide-margin group had significantly longer overall surival （t =4.266, P =0. 031） than patients in the narrow-margin group. Conclusions： the cutting edge of HCC patients with PVTT should be longer than others which can lengthen the survival time and the free-survival time reasonably.