中国实用外科杂志

中国实用外科杂志

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肝细胞癌切除术后复发行二次手术切除疗效研究

许    贇a，沈    强a，王    能a，王    义b，钱国军a   

  1. 第二军医大学东方肝胆外科医院  a.微创一科  b.肝外二科，上海200438
  • 出版日期:2016-06-01 发布日期:2016-05-31

  • Online:2016-06-01 Published:2016-05-31

摘要：

目的    评估二次肝切除手术（RHR）治疗切除术后复发型肝细胞癌（HCC）病人的安全性和有效性。方法    回顾性分析2007年1月至2011年12月第二军医大学东方肝胆外科医院HCC术后首次复发未行任何治疗的175例行RHR的病人临床资料，统计长期存活率并行预后相关因素分析。结果    RHR后严重并发症的发生率为7.4%，1、3、5年总存活率和无瘤存活率分别为92%、71%、51%和为75%、43%、36%。高龄（>65岁）、首发肿瘤巴塞罗那（BCLC）分期B期、肿瘤出现微血管侵犯、肿瘤直径和肿瘤包膜不完整是影响RHR后总存活率的风险因素。结论    RHR的适应证应严格掌握，经筛选可行者，其安全性较高且疗效理想。高龄（>65岁）、首发肿瘤BCLC分期B期、肿瘤出现微血管侵犯、肿瘤直径和肿瘤包膜不完整的HCC病人RHR后预后相对较差，考虑可否缩短随访时间或联合其他治疗。

关键词: 肝细胞肝癌, 复发, 二次手术切除

Abstract:

Efficacy and prognostic factors of repeat hepatic resection for recurrent hepatocellular carcinoma：A report of 175 cases        XU Yun*，SHEN Qiang，WANG Neng，et al. *Department of Minimally Invasive Therapy，Hepatobiliary Surgery Hospital，the Second Military Medical University，Shanghai 200438，China
Corresponding author：QIAN Guo-jun，E-mail：qgjs@sina.com
Abstract    Objective    To investigate the safety, efficacy and prognostic factors for the survival in the patients with recurrent hepatocellular carcinoma (HCC) treated with repeat hepatic resection (RHR). Methods    The clinical data of 175 cases of recurrent HCC following resection treated with RHR from January 2007 to December 2011 in Hepatobiliary Surgery Hospital of the Second Military Medical University were analyzed retrospectively. Complication rate, overall survival rates, disease-free survival rates were calculated and prognostic risk factors were analyzed. Results    The severe complication rate after RHR was 7.4%. The 1-,3-,5-year overall survival rates and disease-free survival rates were 92%,71%,51% and 75%,43%,36%, respectively. Elderly patient（>65 years old）, primary HCC at Barcelona Clinic Liver Cancer (BCLC) stage B, microvascular invasion, larger size and incomplete capsule were risk factors for overall survival. Conclusion    Indications of RHR should be managed strictly. For patients who satisfy the indications, RHR is safe and effective. For elderly patients（>65 years old）, primary HCC at BCLC stage B, microvascular invasion, larger size and incomplete capsule, closer follow-up and auxiliary treatment following RHR should be considered to improve relatively poor prognosis of the category.

Key words: hepatocellular carcinoma, recurrence, repeat hepatic resection