急诊肝切除治疗原发性肝癌破裂的预后分析
作者: |
1欧迪鹏,
2杨连粤,
1杨浩,
1曾志军,
1罗义江
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: |
欧迪鹏
Email: douglasou@126.com |
DOI: | 10.3978/.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。
关键词:
肝肿瘤
破裂,自发性
肝切除术
急诊处理
Prognostic analysis of emergency hepatectomy for spontaneous rupture and hemorrhage of hepatocellular carcinoma
CorrespondingAuthor:OU Dipeng Email: douglasou@126.com
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.
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