专题研究(Monographic Study)

急诊肝切除治疗原发性肝癌破裂的预后分析

Published at: 2017年第26卷第1期

欧迪鹏 1 , 杨连粤 2 , 杨浩 1 , 曾志军 1 , 罗义江 1
1 中南大学湘雅医院老年外科,湖南 长沙 410008
2 中南大学湘雅医院普通外科,湖南 长沙 410008
通讯作者 迪鹏 欧 Email: douglasou@126.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.01.005
基金:
湖南省自然科学基金资助项目 13JJ3014

摘要

目的:探讨急诊肝切除治疗原发性肝癌破裂出血的临床效果。方法:回顾性分析2005年1月―2014年12月间57例肝癌破裂出血患者行急诊肝切除手术的临床资料。结果:所有患者顺利实施急诊手术治疗,住院病死率为10.5%。其1、3、5年总体生存率与无瘤生存率分别为77.6%、51.0%、32.7%与69.4%、40.8%、18.4%,中位生存时间为38.7个月。获得随访的49例患者中38例出现复发转移,其中肝内复发18例(47.4%),肝外转移20例(52.6%)。多因素分析显示瘤体>10 cm(HR=2.43,P=0.031)和多发肿瘤结节(HR=0.46,P=0.028)是患者术后生存的独立影响因素。结论:经合理的选择,对可切除的肝癌破裂出血患者实施急诊肝切除手术治疗是挽救生命、获得良好远期疗效的一种治疗方式。


Prognostic analysis of emergency hepatectomy for spontaneous rupture and hemorrhage of hepatocellular carcinoma

Abstract

Objective: To investigate the clinical efficacy of emergency hepatectomy in treatment of spontaneous rupture and hemorrhage of hepatocellular carcinoma (HCC). Methods: The clinical data of 57 patients with rupture and hemorrhage of HCC undergoing emergency hepatectomy from January 2005 to December 2014 were retrospectively analyzed. Results: All patients underwent successful emergency hepatectomy, and the in-hospital mortality was 10.5%. The 1-, 3- and 5-year overall survival rate was 77.6%, 51.0% and 32.7% and disease-free survival rate was 69.4%, 40.8% and 18.4%, respectively, with the median survival time of 38.7 months. Of the 49 patients receiving follow-up, recurrence occurred in 38 cases, including intrahepatic recurrence in 18 cases (47.4%), and extrahepatic metastasis in 20 cases (52.6%). The multivariate analysis showed that tumor size larger than 10 cm (HR=2.43, P=0.031) and multiple lesions (HR=0.46, P=0.028) were independent factors affecting the postoperative survival of the patients. Conclusion: After appropriate selection, emergency hepatectomy for resectable HCC with rupture and hemorrhage is a life-saving and long-term effective treatment.


comments powered by Disqus

全文

引用

引用本文: 迪鹏 欧, 连粤 杨, 浩 杨, 志军 曾, 义江 罗. 急诊肝切除治疗原发性肝癌破裂的预后分析[J]. 中国普通外科杂志, 2017, 26(1): 25-30.
Cite this article as: OU Dipeng, YANG Lianyue, YANG Hao, ZENG Zhijun, LUO Yijiang . Prognostic analysis of emergency hepatectomy for spontaneous rupture and hemorrhage of hepatocellular carcinoma[J]. Chin J Gen Surg, 2017, 26(1): 25-30.