CAJ | 학술논문

目的：探讨肝细胞癌( hepatocellular carcinoma, HCC)伴肝硬化门静脉高压患者行肝切除术的可行性。方法对我院2009年1月—2013年3月收治的肝硬化HCC接受肝切除术512例的临床资料进行回顾性分析,根据术前是否存在门静脉高压将其分为门静脉高压组(143例)和无门静脉高压组(369例),观察比较两组一般资料、手术情况、术后死亡及并发症情况、随访期间生存率,并对两组生存状况、影响生存状况因素及死亡原因进行分析。结果门静脉高压组术前Child-Pugh B级、血清总胆红素>20μmol/L、血白蛋白<35 g/L及输血者所占比例均高于无门静脉高压组,而肿瘤直径≥5 cm者所占比例低于无门静脉高压组,差异均具有统计学意义(P<0．05)。门静脉高压组手术时间、术中出血量、术后住院时间、术后病死率及并发症发生率均高于无门静脉高压组,差异均具有统计学意义(P<0．05)。门静脉高压组随访期间生存率低于无门静脉高压组,两组比较差异有统计学意义(P<0.05)。相关性分析显示,伴门静脉高压、甲胎蛋白>20μg/L、肿瘤直径≥5 cm、肝切除范围>1个肝段、术前无肝动脉化疗栓塞术(TACE)、组织学分化低、切缘<0.5 cm、多发病灶肝硬化HCC患者生存率明显降低(P<0．05)。利用Cox回归模型进行分析后得出肿瘤直径≥5 cm、多发病灶及术前无TACE是导致肝硬化HCC患者肝切除术后死亡的独立危险因子(P<0．05)。结论门静脉高压并非影响肝硬化HCC肝切除术后生存的独立危险因子,HCC伴肝硬化门静脉高压患者可行肝切除术,肝脏功能保护为肝切除术后重要环节。
목적：탐토간세포암( hepatocellular carcinoma, HCC)반간경화문정맥고압환자행간절제술적가행성。방법대아원2009년1월—2013년3월수치적간경화HCC접수간절제술512례적림상자료진행회고성분석,근거술전시부존재문정맥고압장기분위문정맥고압조(143례)화무문정맥고압조(369례),관찰비교량조일반자료、수술정황、술후사망급병발증정황、수방기간생존솔,병대량조생존상황、영향생존상황인소급사망원인진행분석。결과문정맥고압조술전Child-Pugh B급、혈청총담홍소>20μmol/L、혈백단백<35 g/L급수혈자소점비례균고우무문정맥고압조,이종류직경≥5 cm자소점비례저우무문정맥고압조,차이균구유통계학의의(P<0．05)。문정맥고압조수술시간、술중출혈량、술후주원시간、술후병사솔급병발증발생솔균고우무문정맥고압조,차이균구유통계학의의(P<0．05)。문정맥고압조수방기간생존솔저우무문정맥고압조,량조비교차이유통계학의의(P<0.05)。상관성분석현시,반문정맥고압、갑태단백>20μg/L、종류직경≥5 cm、간절제범위>1개간단、술전무간동맥화료전새술(TACE)、조직학분화저、절연<0.5 cm、다발병조간경화HCC환자생존솔명현강저(P<0．05)。이용Cox회귀모형진행분석후득출종류직경≥5 cm、다발병조급술전무TACE시도치간경화HCC환자간절제술후사망적독립위험인자(P<0．05)。결론문정맥고압병비영향간경화HCC간절제술후생존적독립위험인자,HCC반간경화문정맥고압환자가행간절제술,간장공능보호위간절제술후중요배절。
Objective To analyze the feasibility of curative hepatectomy for hepatocellular carcinoma ( HCC) in portal hypertensive ( PH) cirrhotics patients. Methods Clinical data of 512 liver cirrhosis and HCC cases in the hospital during Janu-ary 2009 and March 2013, were retrospectively analyzed. According to the portal venous pressure, the patients were divided into hypertension group (n=143) and non hypertension group (n=369);General data of the postoperative mortality, operation situ-ation, postoperative complications, and survival rates of the 2 group during the follow-up period were compared. Living status and factors influencing the living status and the cause of death of two groups were analyzed. Results Before operation, the pro-portion of Child-Pugh class B, serum total bilirubin >20μmol/L, albumin <35 g/L, blood transfusions were higher than those of non portal hypertension group, the proportion of tumor diameter ≥5 cm were lower than that of non venous pressure groups, and the difference was statistically significant (P<0. 05). In high pressure group, the operation time, intraoperative blood loss, postoperative hospital stay, fatality rate and complication rate after operation were lower than those of non venous pressure group, and the difference was statistically significant (P<0. 05). The survival rate during the follow-up period of hypertension group was lower than that of non hypertension group, and the difference was statistically significant (P<0. 05). It was shown that por-tal hypertension, alpha fetoprotein levels were >20μg/L, the tumor diameter was≥5 cm, liver resection was >1 hepatic seg-ment, no transcatheter hepatic arterial chemoembolization (TACE) before operation, low histologic differentiation was low, cut-ting edge was <0. 5 cm, the survival rate of the patients with multiple lesions HCC decreased significantly (P<0. 05), cox re-gression analysis showed that tumor diameter ≥5 cm, multiple lesion in HCC and no TACE before operation were independent risk factors causing death of patients with cirrhosis of liver after hepatectomy. Conclusion PH is not an independent risk factor for survival for hepatic cirrhosis related HCC patients after hepatic resection, liver resection for patients suffering from HCC with PH is feasible, and liver function protection is important after resection.