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目的比较不同的手术切缘对肝癌患者术后复发及生存的影响,为肝癌患者手术中选择合理切缘提供参考。方法将152例初治的可手术切除肝癌患者随机分为两组,分别按以下标准手术:74例宽切缘组患者按门静脉血流方向远端距肿瘤边缘2cm,近端距肿瘤边缘1cm完整切除;78例窄切缘组患者切除范围距离肿瘤<1cm,切缘无癌残留。应用KaplanMeier法进行生存分析,用Logrank检验分别比较两组的无瘤生存期和总生存期。结果宽切缘组患者平均无瘤生存期为35.5个月,平均总生存期为42.0个月;窄切缘组患者平均无瘤生存期为28.8个月,平均总生存期为37.5个月,两组无瘤生存期(t=6.01,P=0.0142)和总生存期(t=6.23,P=0.0125)比较,差异均有统计学意义。结论按门静脉血流方向远端距肿瘤2cm,近端距肿瘤1cm切除为标准的手术范围可较合理地延长肝癌患者术后无瘤生存期和总生存期。
Objective To compare the effect of different surgical margins on the recurrence and survival of patients with liver cancer, and to provide a reference for the selection of reasonable margins in patients with liver cancer. Methods 152 patients with initially untreated liver cancer were randomly divided into two groups according to the following standard surgery: 74 patients with wide margin margin group according to portal vein flow direction distal to the tumor edge 2cm, the proximal end from the tumor edge 1cm complete Excision; 78 cases of patients with narrow-margin resection range of tumor <1cm, no margin of cancer margin. Survival analysis was performed using the KaplanMeier method. Logrank test was used to compare the tumor-free survival and overall survival of the two groups. Results The average tumor-free survival was 35.5 months in the wide margin group and 42.0 months in the margin-wide margin group. The mean tumor-free survival was 28.8 months in the narrow-margin group, with a mean overall survival of 37.5 months. The difference between the two groups was statistically significant (t = 6.01, P = 0.0142) and overall survival (t = 6.23, P = 0.0125). Conclusion According to the direction of the portal vein blood flow distal 2cm away from the tumor, 1cm proximal to the tumor resection for the standard surgical range can be more reasonable to extend the liver cancer patients after tumor-free survival and overall survival.