中国实用外科杂志

中国实用外科杂志

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解剖性肝切除对肝细胞癌伴微血管侵犯病人预后的影响

张    努，荚卫东，王润东，葛勇胜，马金良，周杭城，王志华   

  1. 中国科学技术大学附属第一医院 安徽省立医院肝脏外科  肝胆胰外科安徽省重点实验室，安徽合肥 230001
  • 出版日期:2018-05-01 发布日期:2018-04-27

  • Online:2018-05-01 Published:2018-04-27

摘要：

目的    探讨解剖性肝切除术肝细胞癌（HCC）合并微血管侵犯（MVI）病人预后的影响。方法    回顾性分析2009 年 12 月至2012年12月因肝细胞癌在中国科学技术大学附属第一医院肝脏外科行根治性手术治疗的198例病例资料，根据《原发性肝癌规范化病理诊断指南（2015版）》对MVI进行病理学分级，分为M0组、M1组和M2组，比较解剖性肝切除和非解剖行肝切除对每组病人的预后影响。结果    198例病人中，111例行解剖性肝切除，87例行非解剖性肝切除。M0、M1、M2 三组间病人术前性别、甲胎蛋白（AFP）值、肿瘤数量及AJCC分期情况及术中、术后情况比较差异无统计学意义（P＞0.05）。M0、M1、M2 三组行解剖性肝切除病人分别为35例、37例和39例，行非解剖性肝切除分别是20例、31例和36例。 M0组和M1组内病人是否行解剖性肝切除对总生存时间差异无统计学意义（P＞0.05），M2组行解剖性肝切除病人术后中位生存时间为32个月，非解剖性肝切除病人中位生存时间为20个月，差异有统计学意义（P=0.003）。结论    解剖性肝切除可以延长高危组病人的总生存时间。

关键词: 肝癌, 解剖性肝切除, 非解剖性肝切除, 微血管侵犯, 预后

Abstract:

Effective of anatomic hepatectomy on prognosis of hepatocellular carcinoma with microvascular invasion                    ZHANG Nu, JIA Wei-dong, WANG Run-dong, et al. Department of Hepatic Surgery，the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital; Anhui Key Laboratory of Hepatopancreatobiliary Surgery,Hefei 230001，China
Corresponding author: JIA Wei-dong, E-mail:jwd1968@sina.com
Abstract    Objective    To study the effective of anatomic hepatectomy on prognosis of hepatocellular carcinoma (HCC) with microvascular invasion (MVI). Methods    The data of 198 patients who underwent curative intent surgery for HCC in Department of Hepatic Surgery，the First Affiliated Hospital of University of Science and Technology of China between December 2009 and December 2012 were analyzed retrospectively. On the basis of the guidelines for pathological diagnosis of liver cancer in 2015, all the cases were divided into three groups (M0, M1, M2) according to the number of microvascular invasion, then the prognosis of each group was compared with and without anatomical liver resection. Results    Among the 198 cases,111 patients underwent anatomic liver resection and 87 patients underwent non-anatomical liver resection. There was no significant difference in preoperative gender, alpha-fetoprotein (AFP) value, tumor number, AJCC staging, intraoperative and postoperative conditions in three groups (P>0.05).M0, M1, M2 group of patients with anatomic liver resection were 35, 37, 39 cases,respectively. Those groups with non-anatomic liver resection were 20, 31, 36 cases,respectively. In M0 and M1 groups, there was no significant difference in survival time in patients with and without anatomic liver resection. However, there was significant difference in survival time in those in M2 group (P=0.003, Median survival time of anatomic and non-anatomic hepatectomy groups were 32 months vs. 20 months). Conclusion    Anatomic hepatectomy has a significantly protective effect on the overall survival time of high-risk HCC patients with MVI.

Key words: hepatocellular carcinoma, anatomic hepatectomy, non-anatomic hepatectomy, microvascular invasion, prognosis