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目的总结儿童期及青春期肝细胞肝癌的临床病理特点,探讨其与预后的关系。方法回顾性分析1996年1月~2004年12月间手术切除并获得随访的56例儿童期及青春期肝细胞肝癌的临床资料和预后状况。选择13项可能对儿童期及青春期肝细胞肝癌切除术后预后产生影响的特征性临床病理因数,利用Cox比例风险模型,与术后生存率的关系进行单因素及多因素分析。结果手术后1、2、3、5年的生存率分别为75.0%、53.7%、44.1%、23.8%。单因素分析提示发现方式、HBsAg阳性、肿瘤多灶性、肿瘤分化程度、门静脉癌栓、肿瘤切缘、输血量、术后是否复发及复发后的治疗措施对预后有影响;多因素分析显示发现方式、门静脉癌栓、输血量、术后是否复发及复发后的治疗措施是影响术后生存率的预后因素。结论儿童期及青春期肝细胞肝癌术后生存率与发现方式、门静脉癌栓、输血量、术后是否复发及复发后的治疗措施密切相关。手术后定期随访,复发后及时采取个体化的综合治疗,有助于提高患儿生存率。
Objective To summarize the clinicopathological features of hepatocellular carcinoma in childhood and adolescence and to explore its relationship with prognosis. Methods The clinical data and prognosis of 56 cases of hepatocellular carcinoma in childhood and adolescence were retrospectively analyzed from January 1996 to December 2004. Thirteen characteristic clinicopathological factors, which may affect the prognosis of hepatocellular carcinoma after hepatocellular carcinoma in childhood and adolescence, were selected. Univariate and multivariate analyzes were performed using the Cox proportional hazard model and the postoperative survival rate. Results The survival rates at 1, 2, 3 and 5 years after operation were 75.0%, 53.7%, 44.1% and 23.8% respectively. Univariate analysis showed that the detection methods, HBsAg positive, tumor multifocal, tumor differentiation, portal vein tumor thrombus, tumor margins, blood transfusion, postoperative recurrence and post-relapse treatment measures have an impact on prognosis; Multivariate analysis showed that Methods, portal vein tumor thrombus, blood transfusion, postoperative recurrence and post-relapse treatment measures are prognostic factors affecting the postoperative survival rate. Conclusions The postoperative survival rate of hepatocellular carcinoma in childhood and adolescence is closely related to the way of finding out, the embolization of portal vein tumor, blood transfusion volume, recurrence and recurrence after treatment. Regular follow-up after surgery, promptly after the recurrence of individualized comprehensive treatment, help to improve the survival rate of children.