原发性肝癌手术治疗的预后因素分析

目的 分析探讨原发性肝癌经过外科手术治疗后影响其预后的危险因素.方法 选取2009年3月到2012年10月的134例就诊于我院肝胆外科的原发性肝癌患者,所有入选病例在手术后均由病理确诊为原发性肝癌(肝细胞癌、胆管细胞癌、混合细胞癌),术后随访临床资料完整,134例原发性肝癌患者根据术后生存时间,分为存活1、3、5年,并且所有入选病例根据术后是否发生转移复发情况分为复发转移组84例和非复发转移组50例,分析患者年龄、性别、乙肝情况、肝硬化情况、AFP值、癌肿大小、包膜情况、病理分型及手术中情况等因素对术后生存率及是否发生复发转移.结果 (1)134例原发性肝癌患者经随访,术后生存情况为1年的生存率为85.5%,3年生存率为66.7%,5年生存率为20.7%,乙肝情况、肝硬化情况、AFP值、癌肿大小、包膜情况是影响术后生存的重要影响因素,具有明显的相关性,差异具有统计学意义(P<0.05);(2)术后复发转移组84例和非复发转移组50例,其中乙肝情况、肝硬化情况、AFP值、癌肿大小、包膜情况是影响术后是否发生复发转移的重要影响因素,具有明显的相关性,差异具有统计学意义(P<0.05);(3)复发转移组84例和非复发转移组50例,比较其术中情况,术中出血量、手术范围、手术时间、肿瘤是否破裂及有无血管侵犯等因素和术后情况无明显的相关性,差异无统计学意义(P>0.05).结论 原发性肝癌术后生存率及复发转移的发生取决于乙肝情况、肝硬化情况、AFP值、癌肿大小、包膜情况,密切关注以上危险因素可提高患者手术疗效,改善术后生存率.

Risk factors affecting the prognosis of primary liver cancer after surgical treatment

Objective To investigate and analyze the risk factors affecting the prognosis of primary liver cancer after surgi-cal treatment.Methods One hundred and thirty-four cases of primary liver cancer admitted into the Department of Hepatobiliary Surgery of the hospital for treatment from March 2009 to October 2012 were recruited for the study.All the cases were pathologically diagnosed as primary liver cancer (hepatocellular carcinoma, cholangiocarcinoma, mixed cell carcinoma) with complete clinical fol-low-up data.According to postoperative survival time, the 134 patients with primary liver cancer were divided into the patients of 1-year survival time, 3-year survival time and 5-year survival time, and all the recruited cases were divided into the recurrence /met-astatis group (n=84) and non-recurrence/metastasis group (n=50) by depending upon whether or not there was metastatis.The effects of such factors as age, gender, hepatitis B, liver cirrhosis, AFP value, tumor size, capsule, pathologic classification and sur-gical treatment on the survival of patients and recurrence and metastatis of carcinoma were analyzed.Results (1) Medical follow-ups indicated that the 1-year survival rate was 85.5%, the 3-year survival rate was 66.7% and the 5-year survival rate was 20.7%. Hepatitis B, liver cirrhosis, AFP value, tumor size and capsule were important factors affecting patient survival after surgery , and clear association and statistical significance could be seen, when comparisons were made between them(P<0.05).(2) In the 84 cases of the recurrence/metastatis group and 50 cases of the non-recurrence/metastatis group, recurrence and metastatis, hepatitis B,liver cirrhosis, AFP value, tumor size and capsule were important factors affecting recurrence and metastatis , and there were clear as-sociation and statistical significance, when comparisons were made(P<0.05).Also in the 84 cases of the recurrence/metastatis group and 50 cases of the non-recurrence/metastatis group, no significant association and statistical significance could be noted in blood loss during surgery, scope of surgery, surgical time, tumor rupture and vascular invasion, when comparisons were made(P<0.05).Conclusion Survival rate as well as recurrence and metastatis after surgery were closely associated with such factors as hepa-titis B, liver cirrhosis, AFP, tumor size and capsule, and close attention to these important risk factors could increase surgical effica-cy and survival rate of these patients.