CAJ | 학술논문

目的探讨伴有门静脉高压症(portal hypertension,PH)的肝硬化相关的原发性肝细胞癌(hepatocellular carcinoma,HCC)患者R0切除的并发症及预后.方法回顾性分析青岛大学医学院附属医院2001年1月至2010年12月获R0切除的肝硬化相关原发性HCC患者523例的临床资料、术后并发症和死亡率和随访结果.结果 523例患者中有146例(27.9％)伴有PH(PH组),377例无PH的证据(72.1％,无PT组);二组的术前资料对比分析显示,PH组患者术前TACE治疗、Child-PughB级、血清白蛋白值＜35g/L、输血和肿瘤直径≤5 cm者显著多于无PH组(P＜0.05).PH组和无PH组患者的手术死亡率为3.4％(死因均为肝病相关)和0.5％(x2=6.676,P=0.010),术后并发症的发生率分别为28.1％和14.3％ (P =0.001),PH组主要是肝病相关并发症(腹水＞800 ml/d、肝功能不全和肝衰竭)高.去除手术死亡的517例患者中,PH组和无PH组患者获R0切除术后的5年生存率分别为46.8％和54.6％ (P =0.047),无瘤生存率分别为37.0％和38.0％(P=0.725);Kaplan-Meier分析显示伴有PH、AFP≥20 ng/ml、肿瘤直径＞5 cm、非孤立型HCC、肝切除范围超过1个肝段和输血的患者其生存率显著降低(P＜0.05);Cox回归分析显示肿瘤直径＞5 cm和非孤立型HCC是影响肝硬化背景HCC患者R0切除术后的独立危险因素(P＜0.05).结论伴有门静脉高压症的HCC患者R0切除术后的并发症和手术死亡率显著高于无PH的患者,肝病相关并发症是主要因素.虽然PH组HCC患者R0切除术后的生存时间显著低于无PH组,但伴有PH不是影响HCC患者R0切除术后长期生存的独立危险因素.
목적 탐토반유문정맥고압증(portal hypertension,PH)적간경화상관적원발성간세포암(hepatocellular carcinoma,HCC)환자R0절제적병발증급예후.방법 회고성분석청도대학의학원부속의원2001년1월지2010년12월획R0절제적간경화상관원발성HCC환자523례적림상자료、술후병발증화사망솔화수방결과.결과 523례환자중유146례(27.9％)반유PH(PH조),377례무PH적증거(72.1％,무PT조);이조적술전자료대비분석현시,PH조환자술전TACE치료、Child-PughB급、혈청백단백치＜35g/L、수혈화종류직경≤5 cm자현저다우무PH조(P＜0.05).PH조화무PH조환자적수술사망솔위3.4％(사인균위간병상관)화0.5％(x2=6.676,P=0.010),술후병발증적발생솔분별위28.1％화14.3％ (P =0.001),PH조주요시간병상관병발증(복수＞800 ml/d、간공능불전화간쇠갈)고.거제수술사망적517례환자중,PH조화무PH조환자획R0절제술후적5년생존솔분별위46.8％화54.6％ (P =0.047),무류생존솔분별위37.0％화38.0％(P=0.725);Kaplan-Meier분석현시반유PH、AFP≥20 ng/ml、종류직경＞5 cm、비고립형HCC、간절제범위초과1개간단화수혈적환자기생존솔현저강저(P＜0.05);Cox회귀분석현시종류직경＞5 cm화비고립형HCC시영향간경화배경HCC환자R0절제술후적독립위험인소(P＜0.05).결론 반유문정맥고압증적HCC환자R0절제술후적병발증화수술사망솔현저고우무PH적환자,간병상관병발증시주요인소.수연PH조HCC환자R0절제술후적생존시간현저저우무PH조,단반유PH불시영향HCC환자R0절제술후장기생존적독립위험인소.
Objective To evaluate the morbidity and prognosis after curative hepatectomy for hepatocellular carcinoma (HCC) in portal hypertensive (PH) cirrhotics.Method Clinical data of 523 patients with cirrhosis-related HCC from January 2001 to December 2010 undergoing hepatectomy at the Dept.of Hepatobiliary Surgery,the Affilated Hospital of Medical College,Qingdao University were studied retrospectively.Results There were 146 (27.9％) patients with PH (PH group) and 377 (72.1％)patients without PH (non-PH group).Patients with TACE before hepatectomy,Child-Pugh class B,serum albumin ＜35 g/L,blood transfusion and tumor size ≤5 cm in PH group were more than that in non-PH group.The mortality within 30 day after resection was 3.4％ in PH group and 0.5％ in non-group (P ＜0.05),the cause of death in PH group was related with liver disease.The postoperative morbidity was 28.1％ and 14.3％ in PH group and non-PH group (P ＜0.001).The overall survival (OS) rate after R0 resection was 46.8％ and 54.6％ in patients with PH and without PH (P =0.047),the disease-free survival was 37.0％ and 38.0％ (P =0.725).By Kaplan-Meier analysis:alcoholism,with PH,AFP≥20 ng/ml,tumor size ＞5 cm and non-solitary type HCC was important factors for OS; tumor size ＞5 cm and non-solitary type HCC was independent predictors for survival.Conclusions The mortality and morbidity in cirrhosis-related HCC patients with PH after R0 resection was higher than that in patients without PH,with most being related to liver disease.PH was not an independent predictor for cirrhosisrelated HCC patients' survival after R0 resection,although the OS time in these patients was significantly shorter than the patients without PH.