CAJ | 학술논문

目的研究影响肝癌自发破裂的危险因素及预后因素,评估选择性一期肝切除的治疗效果.方法从2002年4月至2006年11月在东方肝胆外科医院确诊为肝癌的4209例患者中,有200例肝癌自发破裂.回顾性分析200例自发破裂患者的临床特点和预后因素.评估不同治疗手段的预后,并与随机选取的202例同期未发生破裂的肝癌患者进行对比.结果多因素回归分析显示肝硬化、高血压、血管癌栓、肝外侵犯及肿瘤大于5 cm是肝癌自发破裂的预测因素.在200例肝癌自发破裂患者中,105例行肝切除治疗、33例肝动脉插管化疗栓塞(TACE),62例保守治疗.所有肝癌破裂患者的中位生存时间为6个月(1 ～72个月),1、3、5年总体生存率分别为32.5％、10％和4％.肝切除组患者中位生存时间为12个月(1～72个月),TACE组为4个月(1～30个月),而保守组为1个月(1～19个月).行肝切除的肝癌破裂患者(105例)1、3、5年总体生存率分别为57.1％、19.0％和7.6％,而同期未破裂肝切除肝癌患者(98例)1、3、5年总体生存率分别为77.1％、59.8％和41.2％(P＜0.001).结论对于伴有肝硬化、高血压、血管癌栓、肝外侵犯及肿瘤大于5 cm的肝癌患者,应警惕肝癌自发破裂的高风险.选择性一期肝切除治疗的肝癌破裂患者能够获得长期生存,尽管其总体预后较肝癌未发生破裂患者差.
목적 연구영향간암자발파렬적위험인소급예후인소,평고선택성일기간절제적치료효과.방법 종2002년4월지2006년11월재동방간담외과의원학진위간암적4209례환자중,유200례간암자발파렬.회고성분석200례자발파렬환자적림상특점화예후인소.평고불동치료수단적예후,병여수궤선취적202례동기미발생파렬적간암환자진행대비.결과 다인소회귀분석현시간경화、고혈압、혈관암전、간외침범급종류대우5 cm시간암자발파렬적예측인소.재200례간암자발파렬환자중,105례행간절제치료、33례간동맥삽관화료전새(TACE),62례보수치료.소유간암파렬환자적중위생존시간위6개월(1 ～72개월),1、3、5년총체생존솔분별위32.5％、10％화4％.간절제조환자중위생존시간위12개월(1～72개월),TACE조위4개월(1～30개월),이보수조위1개월(1～19개월).행간절제적간암파렬환자(105례)1、3、5년총체생존솔분별위57.1％、19.0％화7.6％,이동기미파렬간절제간암환자(98례)1、3、5년총체생존솔분별위77.1％、59.8％화41.2％(P＜0.001).결론 대우반유간경화、고혈압、혈관암전、간외침범급종류대우5 cm적간암환자,응경척간암자발파렬적고풍험.선택성일기간절제치료적간암파렬환자능구획득장기생존,진관기총체예후교간암미발생파렬환자차.
Objective To determine the risk factors of ruptured hepatocellular carcinoma (HCC) and to study the prognostic factors of long-term survival.Methods Of the 4209 patients with HCC diagnosed and treated at the Eastern Hepatobiliary Surgery Hospital from Apr 2002 to Nov 2006,200 patients (4.8％) presented with ruptured HCC.These patients were studied retrospectively and the results of treatment were evaluated and compared with a randomly selected group of 202 patients who had no history of rupture and were treated during the study period.Results On multivariate logistic regression analysis,co-existing hypertension and cirrhosis,tumor size ＞5 cm,vascular thrombus and extrahepatic invasion were predictors of spontaneous rupture of HCC.For the 200 patients with spontaneous rupture of HCC,105 patients underwent elective one stage hepatic resection,33 received transcatheter arterial chemoembolization (TACE),and 62 were treated conservatively.The median survival time (MST) for patients with spontaneous rupture of HCC was 6 months (range,1-72 months),and the overall survival rates at 1-,3-and 5-year were 32.5％,10％ and 4％,respectively.The MST was 12 months (range,1-72 months) in the surgical group,4 months (range,1-30 months) in the TACE group and 1 month (range,0-19 months) in the conservative group.The 1-,3-and 5-year overall survival rates in patients with ruptured HCC who received partial hepatectomy were 57.1 ％,19.0％ and 7.6％,respectively,compared with 77.1％,59.8％ and 41.2％ in 98 patients who underwent partial hepatectomy for HCC without rupture (P＜0.001).Conclusions For patients with HCC who had underlying of hypertension and cirrhosis,extrahepatic invasion and tumor size ＞5 cm,there was a high propensity to rupture.Prolonged survival could be achieved in selected patients who received one-stage partial hepatectomy,although the survival results were inferior to the patients had no rupture.