不同手术时机选择对原发性肝细胞癌自发性破裂出血患者治疗效果及预后的影响

Effect of different operation time on therapeutic efficacy and prognosis in patients with spontaneous ruptured bleeding of primary hepatocellular carcinoma

目的分析不同手术时机的选择对原发性肝细胞癌自发性破裂出血患者治疗效果及预后的影响。方法选取49例原发性肝细胞癌自发性破裂出血患者。根据手术时机(原发性肝癌自发性破裂出血至手术开始的时间)选择的不同,分为≤2周组23例和﹥2周组26例。比较两组患者的临床特征、术中出血量、大网膜种植转移发生率、术后并发症的发生率及5年预后情况等。结果两组患者的临床特征、术中平均出血量、术后并发症的发生率、5年生存率、5年中位总生存时间比较,差异均无统计学意义(P﹥0.05);≤2周组患者的大网膜种植转移的发生率低于﹥2周组(P﹤0.05);≤2周组患者中位无病生存时间为15个月,明显长于﹥2周组的9个月(P﹤0.05)。结论与手术时机选择﹥2周比较,原发性肝细胞癌自发性破裂出血患者2周及2周内进行手术治疗,可降低腹腔大网膜种植转移的发生率,延长患者的5年无病生存时间。

Objective To analyze the effect of different operation time on therapeutic efficacy and prognosis in patients with spontaneous ruptured bleeding of primary hepatocellular carcinoma. Method 49 cases of patients with spontaneous ruptured bleeding of primary hepatocellular carcinoma were selected and divided into the ≤2 weeks group (23 cases) and >2 weeks group (26 cases) according to different operation time (interval between spontaneous ruptured bleeding time of primary hepatocellular carcinoma and beginning of operation). Clinical characteristics, intra- operative bleeding volume, incidence of omentum implantation metastasis, post- operative complications and 5 years prognosis were compared between two groups. Result There was no significant difference in the clinical characteristics, mean intra-operative bleeding volume, incidence of post-operative complications, five years survival rate, 5 years median overall survival time between two groups (P>0.05). The incidence of omentum implantation metastasis in ≤2 weeks group was significantly lower than that in >2 weeks group (P<0.05). The median disease-free survival time of the ≤2 weeks group was 15 months, significantly longer than the 9 months in the >2 weeks group (P<0.05). Conclusion Compared to >2 weeks, operation time ≤ 2 weeks in spontaneous ruptured bleeding of primary hepatocellular carcinoma can decrease the incidence of omentum implantation metastasis and extend the 5 years disease-free survival time.