肝功能受损的肝细胞癌患者围手术期的安全性和预后
Perioperative safety and prognosis in hepatocellular carcinoma patients with impaired liver function.
作者信息
Hsia C Y, Lui W Y, Chau G Y, King K L, Loong C C, Wu C W
机构信息
Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taiwan, Republic of China.
出版信息
J Am Coll Surg. 2000 May;190(5):574-9. doi: 10.1016/s1072-7515(00)00259-3.
BACKGROUND
The benefits of liver resection for hepatocellular carcinoma (HCC) patients with concomitant impaired liver function were often considered questionable because of poor postoperative prognosis. This study will clarify whether an acceptable operative risk exists and whether limited resection will compromise the outcomes of these patients.
STUDY DESIGN
Between July 1991 and December 1996, a total of 168 patients with HCC who underwent hepatectomies were enrolled and divided into normal (group A) and impaired (group B) liver function groups according to the value of indocyanine green retention rate at 15 minutes. Clinical features, surgical related features, pathologic features, and disease-free and overall survivals were compared between the groups.
RESULTS
Operative morbidity and mortality in group A were 27.3% and 1.6%, and in group B were 40.0% and 2.5%, respectively (p = 0.129 and 0.506). Disease-free survival and overall survival at 5 years in group A were 43.2% and 59.6%, respectively, and in group B they were 30.6% and 56.8%, respectively (p = 0.607 and 0.378).
CONCLUSIONS
Limited liver resection is safe and provides favorable prognosis in HCC patients with concomitant impaired liver function.
背景
肝细胞癌（HCC）伴肝功能受损患者行肝切除的获益常因术后预后差而受到质疑。本研究将阐明此类患者是否存在可接受的手术风险，以及有限切除是否会影响其预后。
研究设计
1991年7月至1996年12月，共有168例行肝切除术的HCC患者入组，根据15分钟吲哚菁绿潴留率分为肝功能正常组（A组）和肝功能受损组（B组）。比较两组的临床特征、手术相关特征、病理特征、无病生存率和总生存率。
结果
A组手术并发症发生率和死亡率分别为27.3%和1.6%，B组分别为40.0%和2.5%（p = 0.129和0.506）。A组5年无病生存率和总生存率分别为43.2%和59.6%，B组分别为30.6%和56.8%（p = 0.607和0.378）。
结论
有限肝切除对伴肝功能受损的HCC患者是安全的，并能提供良好的预后。
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