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目的探讨解剖性肝切除术与非解剖性肝切除术对肝癌患者预后的影响。方法收集2008年7月至2009年7月于我院行手术治疗的原发性肝癌患者721例,其中317例行解剖性肝切除术,404例行非解剖性肝切除术。用KaplanMeier曲线和log-rank检验比较两组间的预后情况,Cox比例风险回归模型分析预后的影响因素。采用倾向性得分匹配法(PSM)消除组间偏倚。结果全部患者的1、3、5年生存率为85.9%、64.7%和51.5%,1、3、5年无瘤生存率为59.3%、34.0%和25.5%。其中解剖性肝切除术组的1、3、5年生存率为93.1%、74.5%和62.5%,1、3、5年无瘤生存率为69.3%、41.3%和34.9%;非解剖性肝切除术组的1、3、5年生存率为80.2%、56.8%和42.9%,1、3、5年无瘤生存率为51.4%、38.3%和18.7%。两组间生存率和无瘤生存率差异均有统计学意义(P<0.001)。PSM配对后:解剖性肝切除术组的1、3、5年生存率为93.9%、73.3%和59.4%,无瘤生存率为67.9%、37.5%和31.3%;非解剖性肝切除术组的1、3、5年生存率为86.0%、62.8%和52.8%,无瘤生存率为56.8%、33.1%和22.6%。两组间生存率和无瘤生存率的差异均有统计学意义(P=0.010,P=0.024)。多因素分析结果表明肿瘤大小、肿瘤数目、包膜、肝硬化、微血管侵犯、手术方式是影响总体生存的独立危险因素,输血、肿瘤大小、肿瘤数目、包膜、肝硬化、微血管侵犯、手术方式是影响肿瘤无瘤生存的独立危险因素。肝硬化肝癌患者中,解剖性肝切除和非解剖性肝切除两组的生存率和无瘤生存率差异均无统计学意义;非肝硬化肝癌患者中,解剖性肝切除与非解剖性肝切除相比可获得较好的预后(生存率和无瘤生存率:P<0.001)。结论对于肝癌患者来说,解剖性肝切除术较非解剖性肝切除可获得较好的预后。对于肝硬化肝癌患者建议采用非解剖性肝切除术。
Objective To investigate the effect of anatomic liver resection and non-anatomic liver resection on the prognosis of patients with liver cancer. Methods A total of 721 primary hepatocellular carcinoma patients undergoing surgical treatment in our hospital from July 2008 to July 2009 were collected, of which 317 underwent anatomical liver resection and 404 underwent non-anatomical liver resection. The Kaplan Meier curve and log-rank test were used to compare the prognosis between the two groups and the Cox proportional hazards regression model was used to analyze the prognostic factors. Intergroup bias was eliminated using propensity score matching (PSM). Results The 1, 3, 5-year survival rates of all patients were 85.9%, 64.7% and 51.5%, respectively. The 1, 3, 5 year disease-free survival rates were 59.3%, 34.0% and 25.5%, respectively. The 1, 3, 5-year survival rates of anatomical group were 93.1%, 74.5% and 62.5%, respectively. The 1, 3 and 5-year disease-free survival rates were 69.3%, 41.3% and 34.9% The 1, 3, 5-year survival rates were 80.2%, 56.8% and 42.9% in the resection group and 51.4%, 38.3% and 18.7% in 1, 3 and 5 years respectively. The difference between the two groups was statistically significant (P <0.001). After PSM paired, the 1, 3, 5-year survival rates of anatomical group were 93.9%, 73.3% and 59.4% respectively, and the tumor-free survival rate was 67.9%, 37.5% and 31.3% respectively. Non-anatomic liver resection group The 1-, 3- and 5-year survival rates were 86.0%, 62.8% and 52.8% respectively. The tumor-free survival rates were 56.8%, 33.1% and 22.6% respectively. The difference between the two groups was statistically significant (P = 0.010, P = 0.024). Multivariate analysis showed that tumor size, number of neoplasms, envelopment, cirrhosis and microvascular invasion were the independent risk factors influencing overall survival. The number of transfusion, tumor size, tumor number, capsule, cirrhosis, microvascular invasion, operation mode Is an independent risk factor that affects tumor-free survival. There was no significant difference in survival rate and tumor-free survival rate between patients with liver cirrhosis and non-anatomical liver resection. In patients with non-cirrhosis, anatomical liver resection and non-anatomical liver resection A better prognosis was obtained compared to those with no survival (P <0.001). Conclusion For patients with liver cancer, anatomical liver resection than non-anatomical liver resection can get a better prognosis. Non-anatomical liver resection is recommended for cirrhotic patients with liver cancer.