大肝癌切除术中输血与患者预后关系的探讨*

目的:多项研究表明术中输血可能增加恶性肿瘤手术切除后复发的风险，但是对于肝癌，尤其是大肝癌手术切除后复发的影响尚不明确。本研究探讨肝切除术中输血对大肝癌患者预后的影响及意义。方法:回顾性分析166 例接受手术切除的大肝癌患者的临床病理学资料和生存结果，87例术中输血的患者为A 组，79例术中无输血的患者为B 组，采用单因素对数秩比较两组患者的总生存率和无瘤生存率，Cox 比例风险模型初步分析影响预后的可能因素。结果:A 组患者1、3、5 年总生存率和无瘤生存率分别为71.6% 、20.2% 、12.7% 和22.6% 、13.6% 、11.3% ，B 组患者1、3、5 年总生存率和无瘤生存率分别为75.0% 、45.2% 、45.2% 和32.1% 、27.6% 、27.6% ，两组间差异有统计学意义（P<0.05）。 多因素分析发现有无癌栓、病理分级及术中输血是影响肝癌患者术后生存时间的独立危险因素。结论:输血是影响手术切除的大肝癌患者的预后因素之一，可能增加大肝癌患者术后复发的风险，降低生存时间。 

Significance of Introperative Blood Transfusion for the Prognosis of Patients with Large Hepatocarcinoma

Objective: Many studies have shown that introperative blood transfusion may predispose patients to an increased risk of tumor recurrence after surgery. The study was to explore the significance of introperative blood transfusion for patients with large hepatocarcinoma treated with hepatectomy. Methods:The clinicopathologic and survival data of166 consecutive patients with large hepatocarcinoma who underwent hepatectomy between 2002 and 2005 were retrospectively analyzed. Eighty-seven patients who received blood transfusion were enrolled into group A and 79patients who didn’t receive blood transfusion were enrolled into group B. The overall survival and tumor-free survival rates of the two groups were evaluated and compared with univariate log-rank test. The multivariate analysis was performed by Cox proportional hazards model. Results: The 1-, 3-, and 5- year overall survival rates and tumor-free survival rates of all patients were73.2% ,31.5% , and26.2% , and27.0% ,20.1% , and18.0% , respectively. The1-, 3-, and 5-year overall survival rates and tumor-free survival rates of patients in group A were 71.6%,20.2%, and12.7%, and22.6%,13.6%, and 11.3%, respectively. The1-, 3-, and 5-year overall survival rates and tumor-free survival rates of patients in group B were 75.0%,45.2%, and45.2%, and32.1%,27.6%, and27.6%, respectively, with significant differences between the two groups (P<0.05). Multivariate analysis revealed that portal vein tumor thrombus, pathological grade and transfusion were independent risk factors for long-term survival of patients with large hepatocarcinoma. Conclusion:Introperative blood transfusion is one of the predictive factors for the prognosis of patients with large hapetocarcinoma who underwent hepatectomy and may promote tumor recurrence and reduce over all survival rate.