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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。
Objective To evaluate the safety and efficacy of secondary liver resection (RHR) in patients with recurrent hepatocellular carcinoma (HCC) after resection. Methods A retrospective analysis of clinical data of 175 patients with RHR who did not undergo any treatment for the first relapse after HCC surgery at the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University from January 2007 to December 2011 was retrospectively analyzed. The long-term survival rate and the related prognostic factors were analyzed. Results The incidence of serious complications after the RHR was 7.4%. The overall survival and the tumor-free survival at 1, 3 and 5 years were 92%, 71%, 51% and 75%, 43% and 36%, respectively. Elderly (> 65 years), stage BC BCB, tumor microvascular invasion, tumor diameter, and tumor envelope imperfection are risk factors for overall survival after RHR. Conclusion RHR indications should be strictly controlled, the screening of feasible, its higher safety and efficacy. Elderly patients (> 65 years old), BCLC stage B of the first tumor, microvascular invasion of tumor, tumor diameter and tumor capsule incomplete HCC RHR prognosis is relatively poor, consider the possibility of shortening the follow-up time or in combination with other treatments.