中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2009年
2期
99-102
,共4页
樊嘉%周俭%吴志全%汤钊猷%周信达%马曾辰%钦伦秀%王征
樊嘉%週儉%吳誌全%湯釗猷%週信達%馬曾辰%欽倫秀%王徵
번가%주검%오지전%탕쇠유%주신체%마증신%흠륜수%왕정
肝肿瘤%肝切除术%肝移植%预后%肿瘤转移%复发
肝腫瘤%肝切除術%肝移植%預後%腫瘤轉移%複髮
간종류%간절제술%간이식%예후%종류전이%복발
Liver neoplasms%Hepatectomy%Liver transplantation%Prognosis%Neoplasm metastasis%Recurrence
目的 总结原发性肝癌外科治疗的临床经验.方法 回顾性分析复旦大学附属中山医院肝癌研究所1988年1月至2007年12月7566例原发性肝癌外科治疗的临床资料.采用Kaplan-Meier法计算术后生存率和无复发生存率,Log-rank检验比较组间差异,多因素分析采用Cox回归模型.结果 7164例肝癌肝切除患者术后3、5、10年生存率分别为56.29%、41.76%、26.70%,无复发生存率分别为63.92%、56.12%、42.97%,围手术期死亡率为1.54%.肿瘤直径≤5 cm的小肝癌患者术后5、10年生存率分别为58.20%、38.47%.肿瘤直径5 cm的大肝癌患者术后5、10年生存率分别为31.42%、20.43%,两者比较差异有统计学意义(X2=535.568,P<0.01).110例肿瘤降期后切除患者、515例术后复发再次切除患者、168例肝癌合并门静脉主干癌栓患者的5年生存率分别为51.26%、67.28%、26.81%,5年无复发牛存率分别为77.44%、13.01%(统计始于第1次手术)、34.90%.402例肝癌肝移植患者术后3、5年生存率及无复发牛存率分别为60.81%、55.63%及64.47%、58.52%.肿瘤直径、数目、分化程度及大血管侵犯是影响肝癌肝切除患者牛存率及无复发生存率的独立预后因素(X2=200.539,27.536,96.964,216.156,P<0.01).结论 肝癌早期筛查和治疗,手术安全性的提高,综合治疗模式的开展,预防转移、复发研究的突破,显著地提高了肝癌外科治疗的效果.
目的 總結原髮性肝癌外科治療的臨床經驗.方法 迴顧性分析複旦大學附屬中山醫院肝癌研究所1988年1月至2007年12月7566例原髮性肝癌外科治療的臨床資料.採用Kaplan-Meier法計算術後生存率和無複髮生存率,Log-rank檢驗比較組間差異,多因素分析採用Cox迴歸模型.結果 7164例肝癌肝切除患者術後3、5、10年生存率分彆為56.29%、41.76%、26.70%,無複髮生存率分彆為63.92%、56.12%、42.97%,圍手術期死亡率為1.54%.腫瘤直徑≤5 cm的小肝癌患者術後5、10年生存率分彆為58.20%、38.47%.腫瘤直徑5 cm的大肝癌患者術後5、10年生存率分彆為31.42%、20.43%,兩者比較差異有統計學意義(X2=535.568,P<0.01).110例腫瘤降期後切除患者、515例術後複髮再次切除患者、168例肝癌閤併門靜脈主榦癌栓患者的5年生存率分彆為51.26%、67.28%、26.81%,5年無複髮牛存率分彆為77.44%、13.01%(統計始于第1次手術)、34.90%.402例肝癌肝移植患者術後3、5年生存率及無複髮牛存率分彆為60.81%、55.63%及64.47%、58.52%.腫瘤直徑、數目、分化程度及大血管侵犯是影響肝癌肝切除患者牛存率及無複髮生存率的獨立預後因素(X2=200.539,27.536,96.964,216.156,P<0.01).結論 肝癌早期篩查和治療,手術安全性的提高,綜閤治療模式的開展,預防轉移、複髮研究的突破,顯著地提高瞭肝癌外科治療的效果.
목적 총결원발성간암외과치료적림상경험.방법 회고성분석복단대학부속중산의원간암연구소1988년1월지2007년12월7566례원발성간암외과치료적림상자료.채용Kaplan-Meier법계산술후생존솔화무복발생존솔,Log-rank검험비교조간차이,다인소분석채용Cox회귀모형.결과 7164례간암간절제환자술후3、5、10년생존솔분별위56.29%、41.76%、26.70%,무복발생존솔분별위63.92%、56.12%、42.97%,위수술기사망솔위1.54%.종류직경≤5 cm적소간암환자술후5、10년생존솔분별위58.20%、38.47%.종류직경5 cm적대간암환자술후5、10년생존솔분별위31.42%、20.43%,량자비교차이유통계학의의(X2=535.568,P<0.01).110례종류강기후절제환자、515례술후복발재차절제환자、168례간암합병문정맥주간암전환자적5년생존솔분별위51.26%、67.28%、26.81%,5년무복발우존솔분별위77.44%、13.01%(통계시우제1차수술)、34.90%.402례간암간이식환자술후3、5년생존솔급무복발우존솔분별위60.81%、55.63%급64.47%、58.52%.종류직경、수목、분화정도급대혈관침범시영향간암간절제환자우존솔급무복발생존솔적독립예후인소(X2=200.539,27.536,96.964,216.156,P<0.01).결론 간암조기사사화치료,수술안전성적제고,종합치료모식적개전,예방전이、복발연구적돌파,현저지제고료간암외과치료적효과.
Objective To summarize the clinical experienee in surgical treatment for hepatocellular carcinoma (HCC). Methods The clinical data of 7566 HCC patients who had been admitted to Research Institute of Liver Cancer of Fudan University from January 1988 to Deeember 2007 were retrospectively analyzed. The overall survival and recurrence free survival (RFS) rates were eaeulated with Kaplan-Meier survival curve. All the data were analyzed using Log-rank test and Cox regression model. Results The 3-, 5-, 10-year overall survival and RFS rates of 7164 patients with HCC resection were 56.29%, 41.76%, 26.70%, and 63.92%, 56.12%, 42.97%, respectively, and the perioperative mortality was 1.54%. The 5- and 10-year overall survival rates of patients with small HCC (diameter<5 era) were 58.20% and 38.47%, which were significantly higher than 31.42% and 20.43% of patients with large HCC (diameter >5 cm) (X2 =535. 568, P <0.01). The 5-year overall survival rotes of HCC patients with resection after down-staging (n = 110), re-resection after recurrence (n = 515), and tumor thrombus in portal vein (n = 168) were 51.26%, 67.28% and 26.81%, respectively; nd the 5-year DFS rotes were 77.44%, 13.01% (calculated from the first operation) and 34.90%, respectively. The 3- and 5-year overall survival and DFS rates of 402 patients who had undergone liver transplantation were 60.81%, 55.63% and 64.47%, 58.52%. The independent prognostic factors influencing the overall survival and DFS rates were the size, number and differentiation of HCC and intrahepatic vessel invasion (X2 = 200.539, 27. 536, 96.964,216. 156, P <0.01). Conclusions Early screening, improved safety of surgery, combined therapy and breakthrough in the reseaeh of preventing HCC metastasis and reeurrenee will significantly improve the treatment outcome of HCC.
