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目的探讨影响原发性肝细胞癌(hepatocellular carcinoma,HCC)合并门静脉高压症(portal hypertension,PH)患者行R0切除的疗效、安全性及预后的因素。方法肝硬化相关的HCC患者300例,均获获RO切除。根据患者术前是否伴有PH分为PH组和无PH组,比较两组患者的术后并发症和死亡率,采用Kaplan-Meier法分析影响患者R0切除术后生存的因素。采用Cox回归风险模型进行危险因素分析。结果 PH组和无PH组的手术死亡率分别为3.6%和0.5%,两组比较差异有统计学意义(P<0.05)。PH组术后并发症的发生率为22.6%,无PH组为9.7%,两组比较差异有统计学意义(P<0.05),尤其是肝病相关并发症(腹水>800 ml/d、肝功能不全和肝衰竭)的发生率。伴有PH(P<0.05)、甲胎蛋白≥20 ng/ml(P<0.05)、肿瘤直径>5 cm(P<0.05)、非孤立型HCC(P<0.05)、肝切除范围>1段(P<0.05)和术中输血(P<0.05)的患者其生存率明显降低。Cox回归分析显示,肿瘤直径>5 cm和非孤立型HCC是其独立危险因素。结论合并PH可增加HCC患者R0切除后的肝病相关并发症的发生率和手术死亡率,肿瘤直径>5cm和非孤立型HCC是影响患者长期生存的危险因素。
Objective To investigate the efficacy, safety and prognosis of patients with primary hepatocellular carcinoma (HCC) complicated with portal hypertension (PH) after R0 resection. Methods 300 patients with cirrhosis-related HCC were treated with resection of the RO. According to whether the patients with preoperative PH is divided into PH group and non-PH group, comparisons of postoperative complications and mortality between the two groups, using Kaplan-Meier analysis of factors affecting the survival of patients after R0 resection. Cox regression model was used to analyze the risk factors. Results The mortality rates of PH group and non-PH group were 3.6% and 0.5%, respectively. There was significant difference between the two groups (P <0.05). The incidence of postoperative complications was 22.6% in PH group and 9.7% in non-PH group. There was significant difference between the two groups (P <0.05), especially in liver related complications (ascites> 800 ml / d, liver function Incomplete and liver failure) incidence. (P <0.05), tumor diameter> 5 cm (P <0.05), non-isolated HCC (P <0.05), hepatic resection range> 1 (P <0.05) and intraoperative blood transfusion (P <0.05), the survival rate was significantly lower. Cox regression analysis showed that tumors> 5 cm in diameter and non-isolated HCCs were independent risk factors. Conclusions The combination of PH can increase the incidence of liver-related complications and operative mortality after R0 resection in HCC patients. The tumor diameter> 5cm and non-isolated HCC are the risk factors affecting the long-term survival of patients with HCC.