56例中晚期原发性肝癌死亡患者的临床分析

Clinical analysis of 56 fatal patients with advanced liver cancer

目的:分析中晚期原发性肝癌患者的临床特征及死亡原因,探讨影响中晚期原发性肝癌住院患者死亡的危险因素,以期为原发性肝癌的诊治提供参考。方法:收集2015年1月至2020年1月在湖南中医药大学第一附属医院感染科死亡的56例中晚期原发性肝癌患者,对其性别、年龄、临床表现、死亡原因等临床资料进行回顾性分析,采用Cox比例风险回归模型进行单因素和多因素分析。结果:56例死亡患者中,男性患者41例(73.2%),女性患者15例(26.8%);32例患者(57.1%)有慢性乙型病毒性肝炎感染病史,50例患者(89.3%)有肝硬化,29例患者(51.8%)甲胎蛋白平>400μg/L。最常见的临床症状为腹胀(71.4%,40/56)及乏力(62.5%,35/56)。全组患者中位生存时间7.7月。首要死亡原因为多脏器功能衰竭(51.8%,29/56),其次为失血性休克(33.9%,19/56)。Cox回归模型分析结果显示:肿瘤治疗方式、门静脉癌栓与中晚期原发性肝癌患者的预后相关。结论:门静脉癌栓、肿瘤治疗方式是中晚期原发性肝癌的独立预后因素。临床医生应提高原发性肝癌的早期诊断率,尽可能采取多种综合治疗方式治疗早中期肝癌;对晚期原发性肝癌患者以对症支持治疗为主,积极治疗其并发症,尽可能延长患者的生存时间,提高患者的生活质量。

Objective:To analyze the clinical characteristics and causes of death of patients with advanced primary liver cancer,and to explore the risk factors of death in hospitalized patients with advanced primary liver cancer,so as to provide reference for the diagnosis and treatment of primary liver cancer.Methods:A total of 56 patients with advanced primary liver cancer who died in the Department of Infectious Diseases of The First Affiliated Hospital of Hunan University of Chinese Medicine from January 2015 to January 2020 were collected.Their sex,age,clinical manifestations and causes of death were analyzed retrospectively.Cox proportional hazard regression model was used for univariate and multivariate analysis.Results:among the 56 deaths,41 were male(73.2%),15 were female(26.8%),32(57.1%)had a history of chronic hepatitis B infection,50(89.3%)had liver cirrhosis,and 29(51.8%)had alpha-fetoprotein>400μg/L.The most common clinical symptoms were abdominal distension(71.4%,40/56)and fatigue(62.5%,35/56).The median survival time of all patients was 7.7 months.The leading cause of death was multiple organ failure(51.8%),followed by hemorrhagic shock(33.9%).Cox regression model analysis showed that tumor treatment and portal vein tumor thrombus were related to the prognosis of patients with advanced primary liver cancer.Conclusion:Portal vein tumor thrombus and tumor treatment are independent prognostic factors for advanced primary liver cancer.Clinicians should improve the early diagnosis rate of primary liver cancer,adopt as many comprehensive treatment methods as possible to treat early and middle stage liver cancer,give priority to symptomatic support treatment for patients with advanced primary liver cancer,and actively treat their complications as far as possible to prolong the survival time of patients and improve their quality of life.