单发小肝癌合并微血管侵犯解剖性与非解剖性肝切除疗效对比分析

Comparative analysis of anatomic and non-anatomic hepatectomy for single small hepatocellular carcinoma with microvascular invasion

目的对比分析解剖性肝切除术（AR）与非解剖性肝切除术（NR）治疗合并MVI的单发小肝癌的疗效和安全性。方法回顾性分析我院2008年1月至2013年12月收治的84例合并MVI的单发小肝癌手术患者的临床资料。行解剖性肝切除术治疗的患者为AR组，行非解剖性肝切除术治疗的患者为NR组，对比两组患者术中、术后的疗效及生存率。结果（1）AR组平均手术时间（170±41）min，术中出血量≥300 ml 8例（8/35），术中输血例数7例（7/35），NR组平均手术时间（148±35）min，术中出血量≥300 ml 19例（19/49），术中输血例数18例（18/49），两组相比差异有统计学意义（P〈0.05）。（2）AR组的1、2、3年的总生存率为85.7%、68.6%、57.1%，NR组的1、2、3年的总生存率为79.6%、53.1%、42.9%。AR组的1、2、3年的无进展生存率为80.0%、62.9%、51.4%，NR组的1、2、3年的无进展生存率为71.4%、49.0%、38.8%（P〈0.05）。（3）影响合并MVI的HCC患者预后因素分析：单因素分析结果显示：肿瘤最大直径和手术方式是影响合并MVI的HCC患者总体生存和无进展生存的相关因素，AFP水平是影响合并MVI的HCC患者无进展生存的相关因素，差异具有统计学意义（P〈0.05）。多因素分析结果显示：肿瘤最大直径为3.0～5.0 cm和手术方式为非解剖性肝切除术是合并MVI的HCC患者总体生存和无进展生存不良的独立因素，AFP≥20 μg/L和总胆红素≥20 μmol/L是合并MVI的HCC患者无进展生存不良的独立因素，差异具有统计学意义（P〈0.05）。结论对合并微血管侵犯的单发小肝癌患者进行解剖性肝切除术具有更好的临床疗效及安全性。

Objective To compare the efficacy and safety of anatomic hepatectomy and non-anatomic hepatectomy in the treatment of single small Hepatocellular carcinoma with MVI.Methods The clinical data of 84 patients with single small Hepatocellular carcinoma with MVI in Beijing Chaoyang Hospital between January 2008 and December 2013 were retrospectively analyzed. Patients undergoing anatomical hepatectomy were enrolled in the AR group, and the patients undergoing non-anatomic hepatectomy were enrolled in the NR group. The efficacy and survival rate of the two groups were compared.Results （1） Operation time, numbers of patients with volume of intraoperative blood loss ≥300 ml and number of patients with blood transfusion were （170±41）minutes, 8, 7 in the AR group and （148±35）minutes, 19, 18 in the NR group, respectively, with statistically significant differences between the 2 groups （P〈0.05）. （2） The 1-year, 2-year and 3-year overall survival rate were 85.7%, 68.6%, 57.1% in the AR group and 79.6%, 53.1%, 42.9% in the NR group, respectively. The 1-year, 2-year and 3-year progression-free survival rate were 80.0%, 62.9%, 51.4% in the AR group and 71.4%, 49.0%, 38.8%, in the NR group, respectively. There were statistically significant differences between the 2 groups both in the overall survival rate and the progression-free survival rate （P〈0.05）. （3） Prognostic factors analysis of HCC patients with MVI： result of univariate analysis showed that maximum diameter of tumor and surgical procedures were relative factors affecting overall survival and progression-free survival of HCC patients with MVI, AFP level was relative factors affecting progression-free survival of HCC patients with MVI, with statistically significant differences （P〈0.05）. Result of multivariate analysis showed that maximum diameter of tumor between 3.0 and 5.0 cm and non-anatomic liver resection were independent factors affecting poor overall survival and progression-free survival of HCC patients with MVI, and AFP≥20 μg/L and total bilirubin ≥20 μmol/L were independent factors affecting poor progression-free survival of HCC patients with MVI, with a statistically significant differences （P〈 0.05）.Conclusion Anatomic hepatectomy for patients with single small hepatocellular carcinoma with microvascular invasion has better clinical efficacy and safety.