原发性肝细胞癌破裂出血临床治疗策略

A clinical treatment strategy for ruptured hepatocellular carcinoma

目的探讨手术联合介入序贯治疗对原发性肝细胞癌（HCC）破裂出血患者预后的影响。方法回顾分析安徽医科大学第一附属医院2013年3月至2016年12月收治的50例HCC破裂出血患者的临床资料。根据临床治疗方式先后顺序不同分为两组。A组先行介入治疗再行手术治疗（n=20）；B组先行手术治疗再行介入治疗（n=30）。对两组患者的临床及随诊资料进行多因素Cox回归分析，分别计算其1年、2年、3年生存率（0s）。结果两组患者基线资料及围手术期并发症发生情况，无明显差异。A组患者3年总生存率明显优于B组（OS：34％比0％，P〈0．05）。多因素分析结果显示：年龄（艘1．376，P〈0．001，95％vs1．191—1．589）和输血量（HR1．001，P〈0．05，95％CI1．000～1．003）是影响患者长期生存的因素。结论手术联合介入序贯治疗为治疗HCC破裂出血的有效方法，但先行介入治疗后再行手术可提高3年生存率。

Objective To investigate the prognoses of patients with ruptured hepatocellular carcino- ma （HCC） after resection combined with interventional therapy. Methods This retrospective study was conducted on 50 consecutive patients with ruptured hepatocellular carcinoma treated from March 2013 to De- cember 2016 in the First Affiliated Hospital, Anhui Medical University. The patients were divided into two groups according to the different therapies, they underwent： Group A resection after interventional therapy （ n = 20） and Group B interventional therapy after resection （ n = 40 ）. The COX regression multivariate a- nalysis was performed and the 1-year, 2-year, 3-year overall survival rates （OS） were calculated. Results The 3-year OS rates were significantly different （OS： 34% vs. 0% , P =0.044）. Multivariate survival anal- ysis showed that age （HR 1. 376, P 〈 0. 001,95% CI 1. 191 - 1. 589 ） and blood transfusion （ HR 1. 001, P 〈 0.05, 95% CI 1. 000 - 1. 003 ） were the two prognostic factors which affected OS rates of patients. Con- clusions Combined surgical resection and interventional therapy was effective in treating patients with rup- tured hepatoce/lular carcinoma. Resection after interventional therapy gave a better overall survival rate than interventional therapy after resection.