抗病毒治疗对乙型肝炎病毒相关性肝癌根治性切除术后临床转归的影响

摘要

目的：探讨手术前后抗病毒治疗对乙型肝炎病毒（HBV）相关性肝癌根治性切除术后临床转归的影响。方法：回顾性分析135例行肝癌根治性切除术的高载量HBV相关性肝癌患者，依据手术前后是否进行抗病毒治疗分为两组：单纯行根治性切除术的患者为对照组（65例），行根治性切除术联合抗病毒治疗的患者为实验组（70例）。比较两组患者术后Child-Pugh评分、HBV DNA拷贝量、肝储备功能、术后并发症发生情况、术后无瘤生存时间的差异。结果：对照组与实验组在术后不同阶段，HBV DNA拷贝及Child-Pugh评分方面均具有明显统计学差异（P＜0.001）；同时实验组与对照组患者术后急性肝功能衰竭（P=0.0289）、肝性脑病(P=0.0216)、肝肾综合征(P=0.0411)的发病率均具有显著统计学差异；在术后无瘤生存率方面，对照组和实验组患者1年、2年、3年无瘤生存率分别为80.0%、36.9%、13.8%和92.9%、64.3%、31.4%，1年无瘤生存率相比无明显统计学差异（P=0.2598），2年、3年无瘤生存率相比均有明显统计学差异（P=0.0015、P=0.0153），Log Rank分析可得3年总体无瘤生存率差异有统计学意义（P＜0.001）。结论：肝癌根治性切除术联合抗病毒治疗可以明显降低术后并发症的发生率，促进肝功能恢复，延长患者的无瘤生存期。%Objective To investigate the effect of antiviral therapy on the prognosis of patients with HBV re⁃lated hepatocellular carcinoma postoperative before and after operation. Methods Retrospective analysis of the patients with hepatocellular carcinoma in our hospital from June 2008 to June 2012 in the high load HBV as⁃sociated HCC patients, according to whether the patients were to carry out anti viral treatment divided into two groups: Patients with simple radical resection as control group (65 cases in group A), and patients who under⁃went radical resection combined with antiviral therapy were the experimental group (70 cases in group B). The two groups of patients with postoperative Child-Pugh score, DNA HBV copy number, liver reserve function, post⁃operative complications, postoperative tumour-free survival time differences were compared. Results In the control group and the experimental group, DNA HBV copy and Child-Pugh scores were having obvious statisti⁃cal difference (P<0.001) at different stages; At the same time, the experimental group and control group pa⁃tients with postoperative acute liver failure (P=0.0289), hepatic encephalopathy (P=0.0216), the incidence of liv⁃er and kidney syndrome (P=0.0411) were statistically significant differences; Postoperative tumour-free survival rate, the control group and the experimental group were 1 years, 2 years, 3 years of tumour-free survival rates were 80%, 36.9%, 13.8% and 92.9%, 64.3%, 31.4%, respectively. There was no significant statistical difference (P=0.2598) to compared with 1 years without tumor survival rate in experimental group and contril group;Howev⁃er, 2 years, 3 years of tumor free survival rate compared to have obvious statistical difference (P=0.0015, P=0.0153). Rank Log analysis can get 3 years overall disease-free survival rate has statistical significance differ⁃ence (P<0.001). Conclusion Radical resection of liver cancer combined with antiviral therapy can signifi⁃cantly reduce the incidence of postoperative complications, promote the recovery of liver function and prolong the survival period of patients without tumor.