解剖性与非解剖性肝切除治疗原发性肝癌远期疗效的比较

摘要

目的 比较解剖性肝切除与非解剖性肝切除治疗肝癌的远期效果.方法 选择2008年1月至2013年7月就诊于解放军总医院行根治性肝切除术的肝细胞癌患者,共入组260例,获随访236例.回顾其术前基本情况、手术方式、肿瘤情况,随访患者的生存时间和无瘤生存时间.运用多种统计方法分析影响总体生存率和无瘤生存率的因素,并进行多因素分析、分层分析,评估两种不同手术方式对肝癌远期疗效的比较.结果 研究显示,解剖性肝切除组患者5年生存率为75％,优于非解剖性肝切除的65％ (P ＜0.05);无瘤生存率为51％,优于非解剖性肝切除的34％ (P ＜0.05).抗病毒治疗可以延长HbsAg阳性患者的生存时间和无瘤生存时间;手术方式、肿瘤直径、肿瘤分期、抗病毒治疗是影响患者总生存率;手术方式、肿瘤分期、抗病毒治疗、性别影响患者的无瘤生存率.解剖性肝切除可改善肿瘤小于5 cm的患者术后无瘤生存(P=0.098);改善肿瘤TNM分期T1、T2期患者术后无瘤生存(P=0.059),并可显著改善分期T3、T4期患者的术后总体生存时间和无瘤生存时间(P＜0.05).结论 与非解剖肝切除比较,解剖性肝切除治疗原发性肝癌具有一定优越性.%Objective Surgical resection is the primary form of curative treatment for hepatocellular carcinoma.Recent reports suggested that when compared to non-anatomical resection,anatomical liver resection improved prognosis of HCC patients.Whether anatomical liver resection should be the preferred routine procedure remains controversial.Methods The data of 236 HCC patients who underwent curative hepatectomy at the PLA General Hospital from January 2008 to July 2013 were reviewed.The data included basic information,procedure,tumor related information and follow-up data.Factors influencing overall survival and tumor-free survival rates were analyzed by multivariate analysis.Multivariate analysis and stratification analysis were also used to evaluate the long-term efficacy of the different procedures.Results The 5-year survival rate of anatomical liver resection was 75％,which was significantly better than that of non-anatomical resection (65 ％) (P ＜ 0.05).The tumor-free survival rate was 51％,which was significantly better than that of non-anatomical resection (34％) P ＜ 0.05).Antiviral therapy prolonged survival time and tumor-free survival time of HbsAg-positive patients.Surgical procedure,tumor diameter,tumor staging,antiviral therapy were influencing factors of overall survival.Surgical procedure,tumor staging,antiviral therapy were influencing factors of tumor-free survival.Anatomical resection improved the tumor-free survival for patients with tumor diameters less than 5 cm (P =0.098),improved tumor-free survival for patients with TNM stage T1 and T2 (P =0.059),and significantly improved the overall survival and tumor-free survivals for patients with T3,T4 (P ＜ 0.05).Conclusion Anatomical resection is recommended for treatment of patients with hepatocellular carcinoma.