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目的评价肝癌患者肝内微小静脉浸润在外科治疗中的意义。方法回顾性分析305例行肝癌切除术患者的临床和病理资料,根据肿瘤病理特点,分为镜下微小静脉浸润组、肉眼静脉浸润组、无静脉浸润组,分析各组的生存率,多因素分析肝癌微小静脉浸润对术后生存的影响。结果微小静脉浸润组132例(43．2%),肉眼静脉浸润组70例(23．0%),无静脉浸润组103例(33．8%),肉眼静脉浸润组的标本全部伴有镜下微小静脉浸润,本组微静脉浸润者202例(66．2%)。瘤体越大,静脉浸润的概率越大。微静脉浸润组中位生存时间29．4个月,术后1、3、5年累积生存率分别是63．6%、38．6%、25．8%；肉眼静脉浸润组中位生存时间9．4个月,术后1、3、5年累积生存率分别是35．7%、11．4%、4．3%；无静脉浸润组中位生存时间48．4个月,术后1、3、5年累积生存率分别是85．4%、59．2%、48．5%。Cox回归分析示,微静脉浸润、肉眼静脉浸润、肿瘤大小及数目、手术切缘是影响肝癌患者术后生存的重要因素,微静脉浸润的相对危险度(HR)是1．926。结论肝癌肝内微小静脉浸润是肿瘤恶性进展的关键阶段,也是影响术后生存的重要因素。
Objective To evaluate the significance of intrahepatic venous invasion in patients with hepatocellular carcinoma during surgical treatment. Methods The clinical and pathological data of 305 patients undergoing resection of liver cancer were retrospectively analyzed. According to the tumor pathological features, they were divided into microsurgery infiltration group, macroscopic vein infiltration group and non-vein infiltration group. The survival rates, multifactorial factors Analysis of microinjection of HCC into postoperative survival. Results 132 cases (43.2%) in the venous infiltration group, 70 cases (23.0%) in the macroscopic infiltration group and 103 cases (33.8%) in the infiltration without vein group all had microscopic Under the tiny vein infiltration, this group of 202 cases of venous invasion (66.2%). The larger the tumor, the greater the probability of venous invasion. The median survival time of microvessel infiltration group was 29.4 months, and the cumulative survival rates at 1, 3 and 5 years after surgery were 63.6%, 38.6% and 25.8% respectively. The median survival time 9.4 months, 1, 3, 5 years after the cumulative survival rates were 35.7%, 11.4%, 4.3%; no vein infiltration group median survival time of 48.4 months after surgery The cumulative survival rates at 1, 3 and 5 years were 85.4%, 59.2% and 48.5% respectively. Cox regression analysis showed that the microvessel infiltration, the infiltration of the macroscopic vein, the size and the number of the tumors, and the surgical margin were the important factors influencing the postoperative survival of HCC patients. The relative risk of micro venous invasion (HR) was 1.926. Conclusion Small intrahepatic venous invasion of hepatocellular carcinoma is a critical stage of malignant tumor progression and an important factor affecting postoperative survival.