肝细胞癌根治性切除术后肝内复发的危险因素分析

目的探讨肝细胞癌根治性切除术后肝内复发的独立危险因素，为肝细胞癌的临床综合治疗提供依据。方法回顾性分析实施肝癌根治性切除的194例肝细胞癌患者的临床资料，将全部病例以术后复发时间2年为界，划分为2年内复发组和2年内未复发组，比较两组之间21项可能影响肝细胞癌术后肝内复发的临床指标的差异。结果单因素分析结果示：2年内复发组的术前血清AFP浓度〉20ng／ml、术前血清AST浓度〉40U／L、术前血清ALP浓度〉135U／L、术前血清GGT浓度〉50U／L、血清HBsAg测定为阳性、肿瘤最大直径〉5cm、肿瘤病灶数目为2个、手术持续时间≥180min、手术中总失血量≥1000ml、手术中有输血的病例数的构成比高于2年内未复发组，且差异有统计学意义。多因素分析结果显示术前血清ALP浓度、肿瘤最大直径、肿瘤病灶数目、手术中总失血量是影响肝细胞癌术后肝内复发的有统计学意义的因素。结论肝细胞癌术后肝内复发是多种因素的共同作用的结果，术前血清ALP浓度、肿瘤最大直径、肿瘤病灶数目、手术中总失血量是影响肝细胞癌术后肝内复发的独立的危险因素。

Analysis of risk factors influencing intrahepatic recurrence of hepatocellular carcinoma after curative resection

Objective To explore the risk factors influencing intrahepatic recurrence of hepatocellu： lar carcinoma （HCC） after curative resection and to provide the reference for comprehensive therapy. Methods We retrospectively analyzed the clinical and pathologic data of 194 patients who underwent curative resection for HCC at the Tumor Hospital of Guangxi Medical University from January 2001 to January 2005. According to the postoperative recurrence time in two years, the patients were divided into two groups ： recurrence and non-recurrence.. Twenty-one factors influencing postoperative intrahepatic recurrence of HCC were statistically analyzed to see the difference between the two groups. Results Univariate analysis showed that the constituent ratio of patients in the recurrence group was higher than that of the non-recurrence group. Preoperative serum AFP was 〉 20 ng/ml, preoperative serum aspartic transaminase （AST） 〉40 U/L, preoperative serum ALP 〉 135 U/L, and preoperative serum γ-glutamyl transpeptidase （GGT） 〉50 U/L. Also serum hepatitis B surface antigen（HbsAg） was positive, tumor maximum diameter 〉5 cm, the number of tumor nodules 2, operative time ≥ 180 min, and intraoperative bleeding volume ≥ 1000 ml. The difference was not statistically significant （ P 〈 0.05 ）. The result of multivariate analysis indicated that preoperative serum ALP 〉 135 U/L, tumor maximum diameter 〉 5 cm, 2 tumor nodules and intraoperative bleeding volume.≥ 1000 ml were the factors influencing postoperative intrahepatic recurrence. Conclusions Recurrence after curative resection of hepatocellular carcinoma attributes to various factors. The independent risk factors affecting intrahepatic recurrence of HCC after curative resection include preoperative ALP, maximum tumor diameter, number of tumor nodules and bleeding volume during operation.