目的 探讨精准序贯治疗对原发性肝癌的疗效.方法 回顾性分析2005年5月至2010年6月解放军空军总医院207例可手术切除的原发性肝癌患者的临床资料,81例采用常规治疗(常规治疗组),126例采用精准序贯治疗(精准序贯治疗组),对两组患者围手术期因素、术后序贯治疗和随访情况进行对比分析研究.计量资料组间比较采用方差分析或协方差分析,计数或等级资料采用率或构成比表示,组间比较采用x2检验或秩和检验,多因素分析采用COX回归模型.结果 常规治疗组与精准序贯治疗组在术前对于直径＜1 cm肿瘤发现率分别为18％ (2/11)和81％( 22/27),两组比较,差异有统计学意义(F=10.876,P＜0.05)；平均手术时间分别为(222±30) min和(186±36) min,两组比较,差异有统计学意义(F =7.390,P＜0.05)；平均切除肝脏体积分别为(133±88)ml和(75±29)ml,两组比较,差异有统计学意义(F=46.996,P＜0.05)；术中平均失血量分别为(327 ±46) ml和(189±60) ml,两组比较,差异有统计学意义(F =31.025,P＜0.05)；围手术期平均输血率分别为51％ (41/81)和24％(30/126),两组比较,差异有统计学意义(F=14.556,P＜0.05)；术后并发症发生率分别为20％( 16/81)和13％(17/126),两组比较,差异有统计学意义(F =4.017,P＜0.05)；术后平均住院时间分别为(26±17)d和(21±12)d,两组比较,差异有统计学意义(F =6.315,P＜0.05).在ALT、Alb、Child-Pugh评分方面,常规治疗组在介入治疗前后改变明显；精准序贯治疗组在介入治疗前后改变不明显.常规治疗组与精准序贯治疗组术后1、2、3年的肿瘤复发率分别为31％(25/81)、38％ (27/71)、48％(31/65)和17％ (21/126)、22％( 17/76)、26％ (8/31)；术后1、2、3年生存率分别为77％ (62/81)、75％(53/71)、60％( 39/65)和87％(110/126)、87％(66/76)、84％(26/31),两组患者预后比较,差异有统计学意义(x2=4.958、4.292、4.168,4.062、3.640、5.470,P＜0.05).结论 对原发性肝癌患者进行术前病情的精准评估、术中精准肝切除以及术后精准介入治疗等系列精准序贯治疗能够有效控制肿瘤复发,最大限度保护肝功能,有利于提高患者生存率.
目的 探討精準序貫治療對原髮性肝癌的療效.方法 迴顧性分析2005年5月至2010年6月解放軍空軍總醫院207例可手術切除的原髮性肝癌患者的臨床資料,81例採用常規治療(常規治療組),126例採用精準序貫治療(精準序貫治療組),對兩組患者圍手術期因素、術後序貫治療和隨訪情況進行對比分析研究.計量資料組間比較採用方差分析或協方差分析,計數或等級資料採用率或構成比錶示,組間比較採用x2檢驗或秩和檢驗,多因素分析採用COX迴歸模型.結果 常規治療組與精準序貫治療組在術前對于直徑＜1 cm腫瘤髮現率分彆為18％ (2/11)和81％( 22/27),兩組比較,差異有統計學意義(F=10.876,P＜0.05)；平均手術時間分彆為(222±30) min和(186±36) min,兩組比較,差異有統計學意義(F =7.390,P＜0.05)；平均切除肝髒體積分彆為(133±88)ml和(75±29)ml,兩組比較,差異有統計學意義(F=46.996,P＜0.05)；術中平均失血量分彆為(327 ±46) ml和(189±60) ml,兩組比較,差異有統計學意義(F =31.025,P＜0.05)；圍手術期平均輸血率分彆為51％ (41/81)和24％(30/126),兩組比較,差異有統計學意義(F=14.556,P＜0.05)；術後併髮癥髮生率分彆為20％( 16/81)和13％(17/126),兩組比較,差異有統計學意義(F =4.017,P＜0.05)；術後平均住院時間分彆為(26±17)d和(21±12)d,兩組比較,差異有統計學意義(F =6.315,P＜0.05).在ALT、Alb、Child-Pugh評分方麵,常規治療組在介入治療前後改變明顯；精準序貫治療組在介入治療前後改變不明顯.常規治療組與精準序貫治療組術後1、2、3年的腫瘤複髮率分彆為31％(25/81)、38％ (27/71)、48％(31/65)和17％ (21/126)、22％( 17/76)、26％ (8/31)；術後1、2、3年生存率分彆為77％ (62/81)、75％(53/71)、60％( 39/65)和87％(110/126)、87％(66/76)、84％(26/31),兩組患者預後比較,差異有統計學意義(x2=4.958、4.292、4.168,4.062、3.640、5.470,P＜0.05).結論 對原髮性肝癌患者進行術前病情的精準評估、術中精準肝切除以及術後精準介入治療等繫列精準序貫治療能夠有效控製腫瘤複髮,最大限度保護肝功能,有利于提高患者生存率.
목적 탐토정준서관치료대원발성간암적료효.방법 회고성분석2005년5월지2010년6월해방군공군총의원207례가수술절제적원발성간암환자적림상자료,81례채용상규치료(상규치료조),126례채용정준서관치료(정준서관치료조),대량조환자위수술기인소、술후서관치료화수방정황진행대비분석연구.계량자료조간비교채용방차분석혹협방차분석,계수혹등급자료채용솔혹구성비표시,조간비교채용x2검험혹질화검험,다인소분석채용COX회귀모형.결과 상규치료조여정준서관치료조재술전대우직경＜1 cm종류발현솔분별위18％ (2/11)화81％( 22/27),량조비교,차이유통계학의의(F=10.876,P＜0.05)；평균수술시간분별위(222±30) min화(186±36) min,량조비교,차이유통계학의의(F =7.390,P＜0.05)；평균절제간장체적분별위(133±88)ml화(75±29)ml,량조비교,차이유통계학의의(F=46.996,P＜0.05)；술중평균실혈량분별위(327 ±46) ml화(189±60) ml,량조비교,차이유통계학의의(F =31.025,P＜0.05)；위수술기평균수혈솔분별위51％ (41/81)화24％(30/126),량조비교,차이유통계학의의(F=14.556,P＜0.05)；술후병발증발생솔분별위20％( 16/81)화13％(17/126),량조비교,차이유통계학의의(F =4.017,P＜0.05)；술후평균주원시간분별위(26±17)d화(21±12)d,량조비교,차이유통계학의의(F =6.315,P＜0.05).재ALT、Alb、Child-Pugh평분방면,상규치료조재개입치료전후개변명현；정준서관치료조재개입치료전후개변불명현.상규치료조여정준서관치료조술후1、2、3년적종류복발솔분별위31％(25/81)、38％ (27/71)、48％(31/65)화17％ (21/126)、22％( 17/76)、26％ (8/31)；술후1、2、3년생존솔분별위77％ (62/81)、75％(53/71)、60％( 39/65)화87％(110/126)、87％(66/76)、84％(26/31),량조환자예후비교,차이유통계학의의(x2=4.958、4.292、4.168,4.062、3.640、5.470,P＜0.05).결론 대원발성간암환자진행술전병정적정준평고、술중정준간절제이급술후정준개입치료등계렬정준서관치료능구유효공제종류복발,최대한도보호간공능,유리우제고환자생존솔.
Objective To investigate the construction and implementation of the concept of precise sequential therapy for primary liver cancer.Methods The clinical data of 207 patients with resectable liver cancer who were admitted to the Air Force General Hospital from May 2005 to June 2010 were retrospectively analyzed.Of all the patients,81 received conventional therapy (conventional therapy group),and the other 126 patients received precise sequential therapy (precise sequential therapy group).The conditions of the patients in perioperative phase,during postoperative sequential treatment and the period of follow-up between the 2 groups were compared.All data were analyzed by using the covariance analysis,analysis of variance,chi-square test or rank sum test.Results The detection rates of lesions with a diameter less than 1 cm,operation time,liver resection volume,intraoperative blood loss,rate of perioperative blood transfusion,duration of postoperative hospital stay,incidences of postoperative complications were 81％ (22/27),( 186 ± 36) minutes,(75 ± 29) ml,( 189 ± 60) ml,24％(30/126),(21 ± 12)days and 13％ (17/126) in the precise sequential therapy group,and 18％ (2/11),(222 ± 30)minutes,(133 ±88)ml,(327 ±46)ml,51％ (41/81),(26 ± 17)days and 20％ (16/81) in the conventional therapy group,respectively,with significant differences between the 2 groups (F =10.876,7.390,46.996,31.025,14.556,6.315,4.017,P ＜ 0.05).No significant difference was observed on the levels of alanine transaminase,albumin and the Child-Pugh score before and after the intervention in the precise sequential therapy group,but significant differences were observed in the conventional therapy group.The 1-,2-,3-year tumor recurrence rates and the 1-,2-,3-year survival rates were 17％ (21/126),22％ (17/76),26％ (8/31) and 87％ (110/126),87％ (66/76),84％ (26/31) in the precise sequential therapy group,and 31％ (25/81),38％ (27/71),48％(31/65 ) and 77％ (62/81),75％ (53/71 ) and 60％ (39/65) in the conventional therapy group,respectively.There were significant differences in the prognosis of the patients in the 2 groups ( x2 =4.958,4.292,4.168,4.062,3.640,5.470,P ＜ 0.05 ).Conclusion Through accurate assessment of the patients' condition before surgery,precise hepatectomy and precise postoperative intervention,the goal of effective control of tumor recurrence,maximum protection of the liver function and improvement of the survival rate can be achieved.
