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目的探讨肝硬化组织学分级对小肝癌合并肝硬化病人肝切除术后长期疗效的影响。方法选取2001年8月至2015年12月在华中科技大学同济医学院附属同济医院肝脏外科接受根治性切除术的小肝癌合并肝硬化病人共500例。根据肝硬化组织学改变严重程度的分级标准(Laennec分级标准),将病人分为轻度、中度和重度肝硬化3组,比较各组病人的无瘤存活率和总体存活率,并分析全组病人的预后影响因素。结果轻度、中度、重度肝硬化组病人的5年无瘤存活率和总体存活率分别为52.4%、26.4%、10.3%和76.8%、50.8%、38.3%。随着肝硬化严重程度的增加,其无瘤存活率和总体存活率均显著降低,差异有统计学意义(P<0.05)。多因素分析结果显示,肝硬化组织学分级、门静脉高压症、肿瘤大小、微血管侵犯、肿瘤分化程度是影响小肝癌术后复发和长期生存的独立危险因素。结论肝硬化组织学分级是影响小肝癌术后复发和长期生存的独立危险因素之一。肝硬化组织学分级对小肝癌合并肝硬化病人的治疗方式选择、判断预后可能具有重要的参考意义。
Objective To investigate the effect of histological grading of cirrhosis on the long-term efficacy of liver resection in patients with small hepatocellular carcinoma and cirrhosis. Methods A total of 500 small hepatocellular carcinoma patients with liver cirrhosis undergoing radical resection at Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2001 to December 2015 were selected. The patients were divided into three groups: mild, moderate and severe liver cirrhosis according to the grade of severity of cirrhosis histological change (Laennec grading standard). The tumor-free survival rate and overall survival rate of all groups were compared and analyzed Group of patients prognostic factors. Results The 5-year tumor-free survival rate and overall survival rate of patients with mild, moderate and severe cirrhosis were 52.4%, 26.4%, 10.3% and 76.8%, 50.8% and 38.3%, respectively. With the increase of the severity of cirrhosis, the tumor-free survival rate and overall survival rate were significantly decreased, the difference was statistically significant (P <0.05). Multivariate analysis showed that histologic grade of liver cirrhosis, portal hypertension, tumor size, microvascular invasion and tumor differentiation were independent risk factors for postoperative recurrence and long-term survival of small hepatocellular carcinoma. Conclusion The histological grade of cirrhosis is one of the independent risk factors for the recurrence and long-term survival of small hepatocellular carcinoma. Liver cirrhosis histological grade of small hepatocellular carcinoma patients with cirrhosis of the treatment options, to determine the prognosis may have important reference value.