原发性小肝癌患者腹腔镜微创术近期疗效及术后复发危险因素分析

Analysis of the short-term effect and risk factors of recurrence in patients with primary small liver cancer undergoing laparoscopic minimally invasive surgery

目的:大样本回顾性分析原发性小肝癌患者腹腔镜微创术近期疗效及术后复发危险因素。方法:对1042例腹腔镜微创术治疗的原发性小肝癌患者进行回顾性分析,采用自制调查统计表收集患者的人口学资料、近期疗效指标(术后3个月病灶控制有效率和1年生存率、2年生存率)、复发相关指标等,并采用多因素Logistic法分析术后复发的相关危险因素。结果:术后3个月1042例患者的病灶控制有效率为79.88%。截至随访截止日(2019年10月),中位生存时间为16.7个月,术后1年、2年总生存率分别为68.95%(706/1024)、36.62%(375/1024)。1042例患者中,14例自始至终未获完全缓解(或痊愈),获完全缓解(或痊愈)的病例中复发674例(占比66.80%)。单因素分析显示,复发组和非复发组患者在年龄、发病年龄、首次病灶清扫数、首次手术肿瘤直径、病灶累及大血管及肿瘤转移等方面比较,差异有统计学意义(均P<0.05)。多因素结果显示:病灶累及大血管、首次病灶清扫数是完全缓解(或痊愈)病例术后复发的危险因素(P<0.05)。结论:原发性小肝癌患者腹腔镜微创术近期疗效欠佳,具有较高的复发率,原发性小肝癌患者术后复发前一般存在明确的诱因,但首次手术病灶数、病灶邻近大血管均是复发的独立危险因素。

Objective:Large sample retrospective analysis of primary small liver cancer patients laparoscopic minimally invasive surgery in the near future efficacy and postoperative recurrence risk factors.Methods:A total of 1042 cases of primary small liver cancer treated by laparoscopic minimally invasive ablation(time range:June 2008 to June 2017)were analyzed retrospectively.The questionnaire of recurrence and treatment outcome of primary small liver cancer was made by ourselves.The survey content included demography data,recurrence situation,recurrence related indicators,etc.The recurrence situation and recurrence related factors of all cases were statistically analyzed.For the recurrence related factors of completely relieved(or cured)cases,single factor analysis was conducted first,then multi factor analysis was conducted,and the effective focus control of cases(three months after operation)was analyzed Rate and short-term(one year,two years)survival.Results:The effective rate of focus control was 79.88%in 1042 cases three months after operation.As of the end date of follow-up(October 2019),the median survival time was 16.7 months,and the overall one-year and two-year survival rates were 68.95%(706/1024)and 36.62%(375/1024)respectively.Of 1042 cases,14 cases were not completely relieved(or cured)from the beginning to the end,and 674 cases(66.80%)recurred.Univariate analysis showed that the age,age of onset,the number of lesions in the first operation,the diameter of the tumor in the first operation,the large blood vessels adjacent to the lesions and the tumor metastasis in the recurrence group and non-recurrence group were compared(P<0.05).Multivariate analysis showed that the number of lesions in the first operation and the large blood vessels adjacent to the lesions were the risk factors of recurrence in patients with complete remission(or recovery)(P<0.05).Conclusion:The short-term effect of laparoscopic minimally invasive surgery for primary small liver cancer is poor,with a high recurrence rate.Generally,there are clear causes before recurrence of primary small liver cancer.However,the number of lesions in the first operation and the large blood vessels adjacent to the lesions are independent risk factors for recurrence.These mean values need to be paid attention to in the clinical.