[1]宋泽兵,胡继雄.肝脏第Ⅵ段肝硬化肝细胞癌患者行不同手术方式的预后比较[J].第三军医大学学报,2018,40(24):2266-2272.
 SONG Zebing,HU Jixiong.Different surgical modalities for hepatocellular carcinoma confined to the Couinaud segment Ⅵ in cirrhotic patients: comparison of the outcomes[J].J Third Mil Med Univ,2018,40(24):2266-2272.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第24期
页码:
2266-2272
栏目:
临床医学
出版日期:
2018-12-30

文章信息/Info

Title:
Different surgical modalities for hepatocellular carcinoma confined to the Couinaud segment Ⅵ in cirrhotic patients: comparison of the outcomes
作者:
宋泽兵胡继雄
中南大学湘雅二医院肝胆外科
Author(s):
SONG Zebing HU Jixiong

Department of Hepatobiliary Surgery, Second Affiliated Hospital, Xiangya Medical College, Central South University, Changsha, Hunan Province, 410011, China

关键词:
肝细胞癌解剖性Ⅵ段切除右后叶切除右半肝切除楔形切除
Keywords:
hepatocellular carcinoma anatomic segmentectomy Ⅵ right posterior sectionectomy right hepatectomywedge resection
分类号:
R730.56;R730.7;R735.7
文献标志码:
A
摘要:

目的    比较位于肝脏第Ⅵ段肝硬化肝细胞癌患者的不同手术治疗方式的预后情况。方法    回顾性分析了从2008年12月至2016年12月行肝切除治疗的2 450位肝硬化肝细胞癌患者,其中有210位于肝脏第Ⅵ段的肝硬化肝细胞癌患者纳入了本研究。纳入病人分为楔形切除组,Ⅵ段切除组,右后叶切除组和右半肝切除4个小组,同时又分为局部切除组(包括楔形切除组和Ⅵ段切除组)和扩大切除组(右后叶切除组和右半肝切除)两个大组。本文分析比较了不同手术方式的围手术期结果,以及1.3.5年总体生存率(OS)和无病生存率(DFS)。结果   楔形切除组、Ⅵ段切除组、右后叶切除组和右半肝切除组所占的比例分别是22.4%(47)、44.3%(93)、19.5%(41)、13.8%(29)。局部切除组的手术时间、术中出血量、平均住院日、术后并发症及手术切缘均少于扩大切除组(P<0.05)。楔形切除组和Ⅵ段切除组就术中出血量、平均住院日及术后并发症方面没有统计学差异(P>0.05)。楔形切除组的1、3、年OS和DFS均低于第Ⅵ段切除组,右后叶切除组和右半肝切除组(P<0.05)。Ⅵ段切除组,右后叶切除组和右半肝切除组1、3、5年OS和DFS无明显差异(P>0.05).围术期没有患者出现死亡。Cox多因素回归分析显示Ⅵ段肝切除(0S:HR=0.56, P=0.028.DFS:HR=0.68, P=0.018),右后叶肝切除(0S:HR=0.63, P=0.015, DFS:HR=0.48, P=0.029),右半肝切除(0S:HR=0.61,P=0.018. DFS:HR=0.54,P=0.031)能提高肝癌患者总体生存率和无病生存率,楔形肝切除(0S:HR=1.36, P=0.032. DFS:HR=1.69, P=0.014),肿瘤数目(≥2) (0S:HR=1.48, P=0.026. DFS:HR=1.61, P=0.022),肿瘤直径(≥5 cm) (0S:HR=1.73, P=0.014. DFS:HR=1.89,P=0.013)能降低肝癌患者总体生存率和无病生存率。结论   对于肿瘤位于肝脏第Ⅵ段的肝硬化肝细胞癌患者来说,解剖性Ⅵ段切除是一种有效可行的手术治疗方式,不仅能做到肿瘤学根治并且能保存大部分有功能的肝组织。手术切除方式、肿瘤数目(≥2)、肿瘤直径(≥5 cm)是肝癌患者预后影响因素。

Abstract:

Objective  To compare the outcomes of cirrhotic patients with hepatocellular carcinoma (HCC) confined to the Couinaud segment Ⅵ undergoing different surgical modalities for tumor resection. Methods   We retrospectively reviewed the data of 2 450 patients undergoing hepatectomy for HCC during the period from December, 2008 to December, 2016, and 210 cirrhotic patients with HCC in the Couinaud segment Ⅵ were enrolled in this study. The enrolled patients underwent local resection [wedge resection (WR) or segmentectomy of the segment VI] or extensive resection [right posterior sectionectomy (RPS) or right hepatectomy (RH)]. We compared the perioperative outcomes, disease-free survival (DFS) and overall survival (OS) rates at 1, 3 and 5 years between the patients receiving local and extensive resection and also among the 4 subgroups treated with different surgical modalities. Results   Of the total of 210 patients, 47 (22.4%) underwent WR, 93 (44.3%) received segmentectomy, 41 (19.5%) had RPS and 29 (13.8%) had RH. Compared with extensive resection, local resection of the tumor was associated with a shorter operation time, shorter hospital stay, less blood loss, lower postoperative morbidity and narrower surgical margins (P<0.05). No significant difference was found in the hospital stay, blood loss or postoperative morbidity between the patients receiving WR and segmentectomy (P>0.05). Among the 4 surgical modalities, WR was associated with the poorest DFS and OS rates at 1, 3 and 5 years (P<0.05), and these rates did not differ significantly among the other 3 modalities (P>0.05). No perioperative mortality occurred in the overall patients. Multivariate Cox regression analysis suggested that segmentectomy (OS: HR=0.56, P=0.028; DFS: HR=0.68, P=0.018), RPS (OS: HR=0.63, P=0.015; DFS: HR=0.48, P=0.029) and RH (OS: HR=0.61, P=0.018; DFS: HR=0.54, P=0.031) improved the OS and DFS of the patients, while WR (OS: HR=1.36, P=0.032; DFS: HR=1.69, P=0.014), a tumor number ≥2  (OS: HR=1.48, P=0.026; DFS: HR=1.61, P=0.022) and a tumor diameter ≥5 cm (OS: HR=1.73, P=0.014; DFS: HR=1.89, P=0.013) were associated with lowered OS and DFS of the patients. Conclusion  For cirrhotic patients with HCC confined to the segment Ⅵ, anatomic segmentectomy of the segment Ⅵ can be an effective surgical modality that not only achieves oncologically radical tumor resection but also preserves the functional parenchyma. The surgical approaches, tumor number (≥2) and tumor diameter (≥5 cm) are all factors affecting the prognosis of the patients.

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更新日期/Last Update: 2019-01-02