围术期使用静脉止血剂降低早期肝癌切除术患者术后无瘤生存.doc

围术期使用静脉止血剂降低早期肝癌切除术患者术后无瘤生存率和总生存率 费国雄 崔龙久 2杨立群1 俞卫锋1* 1.第二军医大学附属东方肝胆外科医院麻醉科 200438 2.第二军医大学附属东方肝胆外科医院特殊二科 200438 摘要 背景：治疗早期肝癌的方法目前主要还是手术切除，但是术后复发仍然是影响肝癌患者远期生存的重要因素，各种止血剂作为肝切除重要的辅助治疗措施，在临床广泛使用，但止血剂对肝癌切除术后复发的影响从未被引起重视。本研究将分析静脉止血剂的使用是否影响肝癌切除术后的远期生存与复发。研究方法：选择2005-2007年间本院手术切除的肝癌患者中肿瘤直径5cm的T1-2N0M0期、肝功能Child-Pugh评分A、B级、病理切缘阴性的504例。用逐步回归法Cox模型分析各因素对患者远期生存复发的影响，用Kaplan-Meier分析使用静脉止血剂是否对患者总生存时间（overall survival OS）和无瘤生存时间(recurrence-free survival RFS)的影响。结果：所有患者的中位随访时间64个月（7-72月）,504例患者中围术期使用过静脉止血剂患者326例，未使用过任何静脉止血剂178例，使用止血剂组5年总生存率较未使用止血剂组低（61.04% VS 75.28%，P=0.002）;使用止血剂组患5年的无瘤生存率较未使用止血剂组患者低（49.08% VS 61.80%，P=0.001）。用逐步回归法Cox模型分析中，围术期使用静脉止血剂是影响患者术后OS（P=0.001相对危险度1.872，95%CI：1.298-2.702）和RFS(P=0.005相对危险度1.523，95%CI：1.136-2.043)的独立危险因素。结论：肝癌切除患者围术期使用静脉止血剂降低肝癌切除患者总体生存时间和无瘤生存时间。 关键词：肝癌；肝切除术；静脉止血剂； Using of intravenous hemostatic during perioperative period is associated with poor overall and recurrence-free survival of early stage hepatocellular carcinoma after curative resection: a retrospective study FEI Guox-iong1 ,CUI Long-jiu2,YANG Li-qun1，YU Wei-feng1* 1.Department of Anaesthesiology, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai,200438,China. 2. Division of Special Treatment II, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai,200438,China. [Abstract] Backgroud: Currently, partial hepatectomy is the mainly treatment for early stage of primary hepatocellular carcinoma(HCC). Meanwhile, the most important factor affecting the long-term survival for patients with HCC is tumor recurrence after surgery. Variety of hemostatic agents were widely used in clinical to reduce the amount of bleeding during or after hepatectomy. However, there is lack of research whether tumor recurrence after hepatectomy is related to perioperative hemostatic agents used. Methods: 504 cases of patients underwent hepatectomy with diameter of HCC less than 5cm, stage of tumor on T1-2N0M0, liver function on Child-Pugh sco