中国实用外科杂志

中国实用外科杂志

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肝中静脉导向肝切除术治疗肝细胞癌临床研究

季顾惟，王    科，李长贤，吴晓峰，焦臣宇，韩    晟，张    慧，武正山，张耀东，邵子诚，卢泽法，张嘉伟，李相成   

  1. 南京医科大学第一附属医院肝移植中心，江苏南京 210029
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要：

目的    探讨以肝中静脉为导向的肝切除术治疗肝细胞癌的临床疗效。方法    回顾性分析2006年6月至2015年6月南京医科大学第一附属医院肝移植中心收治的91例行肝切除获得根治的肝癌病人的临床及随访资料。以肝中静脉的完全显露区分手术方式，分为肝中静脉导向组（30例）和传统组（61例）。早期复发定义为术后1年内肿瘤复发。采用倾向性评分匹配法进行组间1:1配对，分析不同手术方式的临床效果。结果    91例病人中，左半肝和右半肝切除分别为30例和61例，肿瘤直径为9.9（1.5～20.0）cm。病人术后生存时间为48（2～127）个月，1、3、5年的总体存活率为80.1%、58.0%、41.8%，1、3、5年无瘤存活率分别为 57.7%、37.4%、30.3%。肝中静脉导向组与传统组之间的总体存活率和无瘤存活率差异无统计学意义（P>0.05），但传统组的肿瘤早期复发率显著高于肝中静脉导向组（P<0.05）。该结果经倾向性评分匹配分析进一步证实。对所有病人资料进行多因素分析显示，大血管侵犯和卫星灶是术后总体生存的独立预后因素，大血管侵犯是术后无瘤生存的独立预后因素，年龄、甲胎蛋白、手术方式是术后肿瘤早期复发的独立危险因素。结论    肝中静脉导向肝切除术可减少肝细胞癌根治性切除术后早期复发，但总体预后主要取决于肿瘤本身的生物学因素。

关键词: 肝细胞癌, 肝中静脉, 解剖性肝切除

Abstract:

Middle hepatic vein-guidedhepatectomy for treatment of hepatocellular carcinoma: A preliminary clinical study        JI Gu-wei，WANG Ke，LI Chang-xian，et al. Liver Transplantation Center，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
Corresponding author：LI Xiang-cheng，E-mail：drxcli@njmu.edu.cn
Abstract    Objective    To explore the clinical efficacy of middle hepatic vein (MHV)-oriented hepatectomy for treatment of hepatocellular carcinoma (HCC). Methods    A retrospective analysis of the clinical and follow-up data of 91 patients，who received radical treatment by hemihepatectomy at Liver Transplantation Center，the First Affiliated Hospital of Nanjing Medical University between June 2006 and June 2015 was conducted. Surgical approaches were divided into MHV-oriented group and conventional group according to full exposure of the MHV on the dissection plane. Early recurrence was defined as tumor recurrence within the first year after surgery. One-to-one propensity score matching (PSM) analysis of the two groups was performed to investigate the clinical efficacy of different surgical approaches. Results    Among the 91 patients，left and right hemihepatectomy was performed in 30 and 61 patients. Mean tumor size was 9.9 cm (1.5 to 20.0 cm). Median survival time was 48 months (2 to 127 months). The 1-，3- and 5-year overall survival (OS) rates were 80.1%，58.0%，and 41.8%，respectively. Corresponding disease-free survival (DFS) rates were 57.7%，37.4%，and 30.3%. There was no statistic difference between MHV-oriented group and conventional group in terms of OS and DFS; However，early recurrence rate in conventional group was significantly higher than that in MHV-oriented group. The result was further confirmed by PSM. Multivariate analysis of all patients showed that macrovascular invasion and satellite focus were independent prognostic factors for OS，macrovascular invasion was the independent prognostic factor for DFS，and surgical approach was an independent risk factor for early recurrence after surgery. Conclusion  MHV-oriented hepatectomy is associated with decreased early recurrence after radical resection of HCC；However，tumor biology remains the main determinant of overall prognosis.

Key words: hepatocellular carcinoma, middle hepatic vein, anatomical liver resection