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

宋泽兵; 胡继雄

doi:10.16016/j.1000-5404.201807072

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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

临床医学 | 更新时间：2026-01-09

- 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
- Different surgical modalities for hepatocellular carcinoma confined to the Couinaud segment Ⅵ in cirrhotic patients: comparison of the outcomes
- 第三军医大学学报 2018年40卷第24期页码：2266-2272
- 作者机构：
  
  410011 湖南长沙, 中南大学湘雅二医院肝胆外科
- 作者简介：
  
  [胡继雄, E-mail：1038939065@qq.com HU Jixiong, E-mail: 1038939065@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201807072
  中图分类号： R730.56; R730.7; R735.7
- 收稿：2018-07-10，
  
  修回：2018-10-18，
  
  纸质出版：2018-12-30
- 稿件说明：
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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.

Zebing SONG, Jixiong HU. Different surgical modalities for hepatocellular carcinoma confined to the Couinaud segment Ⅵ in cirrhotic patients: comparison of the outcomes[J]. Journal of Third Military Medical University, 2018, 40(24): 2266-2272.
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. DOI： 10.16016/j.1000-5404.201807072.

Zebing SONG, Jixiong HU. Different surgical modalities for hepatocellular carcinoma confined to the Couinaud segment Ⅵ in cirrhotic patients: comparison of the outcomes[J]. Journal of Third Military Medical University, 2018, 40(24): 2266-2272. DOI： 10.16016/j.1000-5404.201807072.

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(

＜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(

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(

＜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(

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

=0.028.DFS:HR=0.68

=0.018)，右后叶肝切除(0S:HR=0.63

=0.015

DFS:HR=0.48

=0.029)，右半肝切除(0S:HR=0.61

=0.018. DFS:HR=0.54

=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

=0.032. DFS:HR=1.69

=0.014)，肿瘤数目(≥2) (0S:HR=1.48

=0.026. DFS:HR=1.61

=0.022)，肿瘤直径(≥5 cm) (0S:HR=1.73

=0.014. DFS:HR=1.89

=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 (

0.05). No significant difference was found in the hospital stay

blood loss or postoperative morbidity between the patients receiving WR and segmentectomy (

0.05). Among the 4 surgical modalities

WR was associated with the poorest DFS and OS rates at 1

3 and 5 years (

0.05)

and these rates did not differ significantly among the other 3 modalities (

0.05). No perioperative mortality occurred in the overall patients. Multivariate Cox regression analysis suggested that segmentectomy (OS: HR=0.56

=0.028; DFS: HR=0.68

=0.018)

RPS (OS: HR=0.63

=0.015; DFS: HR=0.48

=0.029) and RH (OS: HR=0.61

=0.018; DFS: HR=0.54

=0.031) improved the OS and DFS of the patients

while WR (OS: HR=1.36

=0.032; DFS: HR=1.69

=0.014)

a tumor number ≥2 (OS: HR=1.48

=0.026; DFS: HR=1.61

=0.022) and a tumor diameter ≥5 cm (OS: HR=1.73

=0.014; DFS: HR=1.89

=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.

关键词

Keywords

references

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