Hepatectomy for hepatocellular carcinoma patients with macronodular cirrhosis
Hepatectomy for hepatocellular carcinoma patients with macronodular cirrhosis
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DOI：
10.1097/meg.0b013e328351046a
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发表时间：
2012-05
影响因子：
2.1
通讯作者：
Qing-an Zeng;Jiliang Qiu;Jian Hong;Yi Li;Sheng-ping Li;Ruhai Zou;Pin-zhu Huang;Binkui Li;Yun Zheng;X. Lao;Yun-fei Yuan
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文献类型：
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作者：
Qing-an Zeng;Jiliang Qiu;Jian Hong;Yi Li;Sheng-ping Li;Ruhai Zou;Pin-zhu Huang;Binkui Li;Yun Zheng;X. Lao;Yun-fei Yuan
目的原发性肝细胞癌（HCC）合并非小结节性或小结节性肝硬化常行肝切除术。然而，对于患有B型肝炎病毒相关的大结节性肝硬化的患者，切除术的价值仍然未知，因为这种手术可能会出现致命的并发症。方法对85例经手术切除的肝癌合并B型肝炎相关大结节性肝硬化患者的临床病理资料进行分析。另外255例非小结节性和小结节性肝硬化患者在同一时期被随机选择作为对照组。结果与非小结节和小结节肝硬化患者相比，大结节肝硬化患者丙氨酸转氨酶、天冬氨酸转氨酶和谷氨酰转移酶水平升高，Child-Pugh分级升高，15 min吲哚菁绿色留存率（ICG R15）升高，总并发症数增多。&ggr;两组在主要并发症、死亡率、总生存率和无复发生存率方面无显著差异。在表现出低ICG R15（<10%）的患者中，发病率相对较低。考克斯分析确定小肿瘤（≤ 5 cm）和根治性切除是可以预测长期总生存率的独立预后因素。根治性切除可提高大结节性脑卒中患者的无复发生存率。结论大结节型原发性肝癌切除术是安全的，根治性切除是一种积极的治疗方法。体型小的病人是肝切除的好选择。对于ICG R15低的患者，大结节性肝硬化不应排除肝切除术。
Objective Patients with hepatocellular carcinoma (HCC) presenting with nonmicronodular or micronodular cirrhosis are usually treated by hepatectomy. The value of resection for patients with hepatitis B virus-related macronodular cirrhosis, however, remains unknown because of potentially fatal complications of this procedure. Methods Clinicopathological data were analyzed for 85 resected HCC patients with hepatitis B virus-related macronodular cirrhosis. An additional 255 patients with nonmicronodular and micronodular cirrhosis were randomly selected during the same period as the control group. Results Compared with nonmicronodular and micronodular cirrhosis patients, macronodular cirrhotic patients exhibited elevated alanine aminotransferase, aspartate aminotransferase, and &ggr;-glutamyltransferase levels, higher Child–Pugh classification, higher indocyanine green retention rate at 15 min (ICG R15), and more number of total complications. No significant differences were observed between the two groups with regard to major complications, mortality, overall survival, and recurrence-free survival. The morbidity rate was relatively low in patients exhibiting low ICG R15 (<10%). Cox analysis identified small tumors (⩽5 cm) and radical resection as independent prognostic factors that could predict long-term overall survival. Radical resection can result in high recurrence-free survival in macronodular cirrhotic patients. Conclusion Resection is safe for macronodular cirrhotic HCC patients, and radical resection provides a positive outcome. Small-sized patients are good candidates for hepatectomy. Macronodular cirrhosis should not rule out hepatectomy in patients with low ICG R15.