腹腔镜肝癌根治性切除术后肝癌复发的影响因素分析

Influencing Factors of Recurrence of Hepatocellular Carcinoma After Laparoscopic Radical Hepatectomy

目的 分析腹腔镜肝癌根治性切除术后肝癌复发的影响因素。方法 回顾性分析2014年10月至2016年10月我院收治的60例原发性肝癌患者的临床资料,患者均行腹腔镜肝癌根治性切除术。根据患者术后空腹血糖(FBG)水平分组,其中血糖升高者(FBG>6.1mmol·L^-1)21例为A组,血糖正常者(FBG为3.9~6.1mmol·L^-1)39例为B组。比较2组患者术后1、2a肝癌复发率,并采用单因素和多因素Logistic回归分析观察影响患者术后肝癌复发的相关因素。结果 A组术后1a肝癌复发率(52.38%)较B组(25.64%)明显升高,术后2a肝癌复发率(66.67%)较B组(38.46%)亦明显升高(χ^2=4.29、4.35,P均<0.05)。单因素分析发现,复发组临床分期为Ⅲ期、Child-Pugh分级为B级、FBG>6.1mmol·L^-1、术中输血量>200mL、淋巴管浸润、术后甲胎蛋白(AFP)>8.1μg·L^-1、术后无辅助治疗的比例均较未复发组明显升高(P均<0.05);而2组患者性别、年龄、饮酒史、基础肝病史、肝硬化史、肿瘤直径、术前AFP及手术方式比较差异均无统计学意义(P均>0.05)。多因素Logistic回归分析发现,临床分期为Ⅲ期、Child-Pugh分级为B级、FBG的水平>6.1mmol·L^-1、术中输血量>200mL、淋巴管浸润、术后AFP的水平>8.1μg·L^-1、术后无辅助治疗是原发性肝癌患者腹腔镜肝癌根治性切除术后复发的影响因素(P均<0.05)。结论 原发性肝癌患者腹腔镜肝癌根治性切除术后FBG水平升高者术后复发率较高,除此之外,临床分期、Child-Pugh分级、术中输血量、是否存在淋巴管浸润、术后AFP、术后有无辅助治疗均是患者术后肝癌复发的影响因素,因此临床上应加强对此类高危患者的干预和监测,以尽可能减少术后肝癌复发。

Objective To analyze the factors influencing the recurrence of hepatocellular carcinoma after laparoscopic radical hepatectomy. Methods The clinical data of 60 patients with hepatocellular carcinoma admitted to our hospital from October 2014 to October 2016 were retrospectively analyzed. All the patients underwent laparoscopic radical hepatectomy. According to the different levels of fasting blood glucose (FBG), 21 patients with elevated blood glucose (FBG > 6.1 mmol·L^-1 ) were in group A and 39 patients with normal blood glucose (FBG was 3.9-6.1 mmol·L ^-1 ) were in group B. The recurrence rate of hepatocellular carcinoma was compared between the two groups at 1 and 2 years after operation. Univariate and multivariate logistic regression were used to analyze the related factors influencing the recurrence of hepatocellular carcinoma. Results The recurrence rate of hepatocellular carcinoma in the group A (52.38%) was significantly increased compared with the group B (25.64%). The recurrence rate of hepatocellular cancer in the group A (66.67%) was also significantly increased compared with the group B (38.46%;χ^ 2=4.29, 4.35, P <0.05). Univariate analysis showed that the ratio of clinical stages of the relapse group were stage Ⅲ, Child-Pugh grade B, FBG > 6.1 mmol·L^-1 , intraoperative blood transfusion > 200 mL, lymphatic infiltration, postoperative alpha-fetoprotein (AFP)> 8.1 μg·L^-1 , and the proportion of postoperative non-adjuvant treatment were significantly higher than those of the non-relapse group ( P <0.05). There were no significant differences in the history of alcohol consumption, basic liver disease, cirrhosis, tumor diameter, preoperative AFP and operative methods ( P >0.05). Multivariate logistic regression analysis showed that clinical stage Ⅲ, Child-Pugh grade B, FBG level > 6.1 mmol·L^-1 , intraoperative blood transfusion > 200 mL, lymphatic infiltration, postoperative AFP level > 8.1 μg·L^-1 , and postoperative non-adjuvant treatment were the influencing factors of recurrence after laparoscopic radical hepatectomy in the patients with hepatocellular carcinoma ( P < 0.05 ). Conclusion The postoperative recurrence rate of patients with hepatocellular carcinoma with elevated FBG level after laparoscopic radical hepatectomy is higher. In addition, clinical stage, Child-Pugh classification, intraoperative blood transfusion, lymphatic infiltration, AFP after operation, and adjuvant treatment are all the influencing factors of postoperative recurrence of patients with hepatocellular carcinoma. Therefore, it is necessary to add more clinical information. The intervention and monitoring of high-risk patients should be strengthened to minimize the recurrence of hepatocellular carcinoma after operation.