原发性肝癌外科治疗方式选择及术后肿瘤复发防治相关性研究

Surgical Treatment of Primary Liver Cancer and Its Correlation with Tumor Recurrence After Surgical Treatment

目的比较原发性肝癌患者肝切除术和肝移植术的长期疗效,探讨肝脏功能良好的早期肝癌患者肝切除术后复发的影响因素。方法选取原发性肝癌患者77例,其中70例肝切除患者,7例肝移植患者;采用SPSS 20.0统计学软件分析肝切除患者和肝移植患者的生存疗效及肝功能Child-Pugh A级患者的肝切除术后复发的影响因素。结果肝移植组合并肝硬化患者比率显著高于肝切除组(P=0.015);肝切除组肝功能Child-Pugh分级与肝移植组肝功能Child-Pugh分级的差异具有统计学意义(P=0.008);肝移植组患者术前接受TACE治疗比率显著高于肝切除组(P=0.003)。两组患者在性别、年龄、乙肝感染、肿瘤大小、肿瘤分化程度及术后辅助化疗等方面均无统计学差异(P>0.05);肝移植组患者的术后并发症发生率、术中出血量及术中输血率均显著高于肝切除组(P<0.001);但两组患者在围手术期医院死亡率、二次手术率方面比较无显著差异(P>0.05);肝移植组患者的无瘤生存率明显优于肝切除组(P=0.041);单因素分析结果显示:乙肝病毒感染、重度肝硬化、血小板<100×109/L、甲胎蛋白>100 ng/ml和肿瘤中低分化是影响Child-Pugh A级直径≤5 cm的单个小肝癌切除术后肿瘤复发的重要不良预后因素;多因素分析结果显示,重度肝硬化、血小板<100×109/L和肿瘤中低分化是影响Child-Pugh A级直径≤5cm的单个小肝癌切除术后肿瘤复发的独立危险因素。结论肝移植术治疗重度肝硬化的单个小肝癌患者的疗效优于肝切除术,肝移植术可作为首选方法,非重度肝硬化可考虑肝切除术;因此,术前应对肝功能Child-Pugh A级的单个小肝癌患者进行肝硬化严重程度分级,依此选择合适的外科治疗方法。

Objective To compare the long-term therapeutic effect of liver resection and liver transplantation in patients with primary liver cancer ,and to explore the influencing factors of recurrence after hepatectomy in patients with hepatocellular car -cinoma.Methods 77 cases of primary liver cancer patients ,of which 70 cases of hepatic resection patients ,7 cases of liver trans-plantation patients.The statistical software SPSS 20.0 comparative analysis of hepatic resection patients and patients with liver transplantation survival efficacy and child Pugh class A patients with liver resection and the factors influencing postoperative re -currence.Results Liver combined transplantation and in patients with liver cirrhosis ratio was higher than that in liver resection group（ P=0.015）;liver resection group child Pugh grading and hepatic transplanted liver function of child Pugh grading differ -ence was statistically significant （P=0.008）;liver transplantation patients received TACE ratio was higher than that in liver re -section group（P=0.003）.Two groups of patients were no significant difference in gender ,age,hepatitis B infection,tumor size, tumor differentiation and postoperative adjuvant chemotherapy and other aspects （P〉0.05）;liver transplantation group patients the incidence of postoperative complications ,intraoperative bleeding and blood transfusion rate were significantly higher than those in liver resection group（P〈0.001）;but 2 patients in the perioperative nosocomial mortality , surgery rate showed no significant difference（P〉0.05）;liver transplantation in patients with tumor free survival rate was significantly better than the liver resection group（P=0.041）;the results of univariate analysis showed that hepatitis B virus infection and severe liver cirrhosis ,platelet 〈100 ＆#215;109/L,〉100 ng/ml and tumor AFP low differentiation is an important prognostic factors for tumor recurrence of small hep -atocellular carcinoma resection of single Child-Pugh a diameter less than 5cm;the results of multivariate analysis showed that se-vere liver cirrhosis ,blood Effect of child Pugh a less than 5 cm in diameter of a single small hepatocellular carcinoma resection of the independent risk factors of postoperative tumor recurrence is low in 〈100 ＆#215;109/L and tumor differentiation.Conclusion Liver transplantation in the treatment of severe cirrhosis of single small hepatocellular carcinoma patients with curative effect is better than that of liver resection ,liver transplantation can be used as the preferred method ,non severe cirrhosis may be considered for liver resection;therefore ,preoperative deal with child Pugh class a single small hepatocellular carcinoma in patients with liver cirrhosis severity grading ,and choose appropriate surgical treatment.