發(fā)布時(shí)間：2018-06-28 19:11

  本文選題：肝細(xì)胞癌 + 預(yù)后　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探究影響HCC患者行肝部分切除術(shù)后遠(yuǎn)期生存的因素,以期能為HCC患者的臨床治療及預(yù)后評(píng)估提供理論依據(jù)。方法:回顧性分析237例術(shù)后生存時(shí)間超過(guò)5年HCC患者的臨床及隨訪資料,選擇可能影響患者預(yù)后的因素,包括:性別、年齡、腫瘤數(shù)目、腫瘤大小、BCLC、肝功能Child-pugh分級(jí)、ALT、AST、TBIL、GGT、ALB、AFP、圍手術(shù)期輸血、腫瘤是否復(fù)發(fā)及復(fù)發(fā)后治療等變量。采用SPSS 22.0軟件進(jìn)行計(jì)算分析,Kaplan-Meier法計(jì)算患者的無(wú)瘤生存率及總體生存率,Log-rank檢驗(yàn)進(jìn)行單因素分析,多危險(xiǎn)因素采用COX模型分析,篩選出影響HCC術(shù)后生存時(shí)間較長(zhǎng)患者復(fù)發(fā)及遠(yuǎn)期生存的獨(dú)立預(yù)后因素。結(jié)果:單因素分析提示腫瘤數(shù)目、BCLC、圍手術(shù)期輸血是術(shù)后生存期較長(zhǎng)患者腫瘤復(fù)發(fā)的危險(xiǎn)因素,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素分析提示腫瘤數(shù)目及圍手術(shù)期輸血是術(shù)后生存時(shí)間較長(zhǎng)患者腫瘤復(fù)發(fā)的獨(dú)立影響因素。單因素分析顯示:性別、年齡、腫瘤數(shù)目、BCLC、圍手術(shù)期輸血、腫瘤復(fù)發(fā)后治療方式與術(shù)后生存時(shí)間較長(zhǎng)患者的預(yù)后相關(guān),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。所有被納入本研究的患者中,有101例(42.6%)發(fā)生腫瘤復(fù)發(fā),根據(jù)患者復(fù)發(fā)后不同的治療方式納入Log-rank檢驗(yàn),再次接受手術(shù)治療患者的中位生存時(shí)間顯著長(zhǎng)于非手術(shù)患者(P0.05)。COX多因素回歸分析顯示:年齡、腫瘤數(shù)目、圍手術(shù)期輸血是HCC術(shù)后生存時(shí)間較長(zhǎng)患者預(yù)后的獨(dú)立影響因素,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、對(duì)于術(shù)后生存時(shí)間較長(zhǎng)的HCC患者,性別、年齡、腫瘤數(shù)目、BCLC、圍手術(shù)期是否輸血以及腫瘤復(fù)發(fā)后治療方式有關(guān),其中年齡、腫瘤數(shù)目、圍手術(shù)期輸血是其遠(yuǎn)期生存的獨(dú)立影響因素。2、術(shù)后生存時(shí)間超過(guò)5年的HCC患者復(fù)發(fā)后再次手術(shù)治療效果顯著好于非手術(shù)治療。
[Abstract]:Objective: to explore the factors influencing the long-term survival of HCC patients after partial hepatectomy, and to provide theoretical basis for the clinical treatment and prognosis evaluation of HCC patients. Methods: the clinical and follow-up data of 237 patients with HCC whose survival time was more than 5 years after operation were analyzed retrospectively. The factors that might influence the prognosis of HCC patients were selected, including sex, age, tumor number. BCLC, Child-pugh grade of liver function, liver function and liver function. SPSS22.0 software was used to calculate the tumor-free survival rate and overall survival rate of patients by Kaplan-Meier method. The single factor analysis was performed by Log-rank test, and the multiple risk factors were analyzed by Cox model. The independent prognostic factors affecting the recurrence and long-term survival of HCC patients were screened. Results: univariate analysis showed that tumor number and perioperative blood transfusion were the risk factors of tumor recurrence in patients with long survival period (P0.05). Multivariate analysis suggested that tumor number and perioperative blood transfusion were independent factors of tumor recurrence in patients with long postoperative survival time. Univariate analysis showed that sex, age, tumor number and BCLC, perioperative blood transfusion, treatment methods after tumor recurrence and the prognosis of patients with longer survival time were significantly different (P0.05). Of all the patients enrolled in the study, 101 (42.6%) developed tumor recurrence, which was included in the Log-rank test according to the different treatment methods after recurrence. The median survival time of patients undergoing reoperation was significantly longer than that of non-operative patients (P0.05) .Cox multivariate regression analysis showed that age, tumor number and blood transfusion in perioperative period were independent factors influencing the prognosis of patients with HCC. The difference was statistically significant (P0.05). Conclusion: the sex, age, tumor number, blood transfusion during perioperative period and the treatment method after tumor recurrence are related to the survival time of HCC patients, age and tumor number. Perioperative blood transfusion was the independent factor of long-term survival. The recurrence of HCC patients with survival time of more than 5 years after operation was significantly better than that of non-operative treatment.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

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本文編號(hào)：2079049