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  • 黄杨卿,杨甲梅*,沈伟峰.肝内胆管细胞癌肝切除治疗术中经大网膜静脉注射丝裂霉素预防复发疗效分析[J].第二军医大学学报,2008,29(8):0963-0966    [点击复制]
  • HUANG Yang-qing, YANG Jia-mei*, SHEN Wei-feng.Preventive effect of mitomycin C injection via great omentum vein during resection of intrahepatic cholangiocarcinoma against carcinoma recurrence[J].Acad J Sec Mil Med Univ,2008,29(8):0963-0966   [点击复制]
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肝内胆管细胞癌肝切除治疗术中经大网膜静脉注射丝裂霉素预防复发疗效分析
黄杨卿,杨甲梅*,沈伟峰
0
(第二军医大学东方肝胆外科医院特需治疗科,上海 200438)
摘要:
目的:探讨肝内胆管细胞癌(intrahepatic cholangiocarcinoma,IHCC)肝切除治疗术中经大网膜静脉注射丝裂霉素(mitomycin-C,MMC)对预防术后肿瘤复发的价值。方法:回顾分析2000年1月至2004年6月我院收治的73例IHCC行肝切除术患者的临床资料。术中经大网膜静脉注射10 mg MMC的用药组共计38例,未行任何化疗药物注射的对照组共计35例,随访术后复发情况,并作统计学分析。结果:两组患者在年龄、性别、是否合并病毒行肝炎、肝硬化、术前是否接受肝细胞癌动脉导管化疗栓塞(TACE)等治疗、肿瘤大小、肿瘤数量、肿瘤是否合并门静脉或胆管癌栓、术后是否接受TACE等临床资料上无统计学差异。多因素分析提示术后复发与肿瘤数量及大小有关,危险系数分别为1.877(P=0.001)及1.391(P=0.029 4),MMC用药与否对术后复发无明显影响。用药组与对照组术后复发时间,即无瘤生存时间无统计学差异,中位无瘤生存时间分别为术后5个月及3个月(P=0.125 3)。术后6个月、1年、2年、3年复发率分别为:65.79%,68.57%(P=0.800 4);81.58%,94.29%(P=0.099 0);89.47%,97.14%(P=1.679 55);92.11%,97.14%(P=0.344 7)。结论:肝切除术中经大网膜静脉注射MMC(10 mg)对预防IHCC术后肿瘤复发可能没有确切价值,但仍有待进一步的前瞻性研究证实。
关键词:  肝内胆管细胞癌  肝切除术  复发  大网脉静脉  丝裂霉素
DOI:10.3724/SP.J.1008.2008.00963
投稿时间:2008-02-27修订日期:2008-04-16
基金项目:
Preventive effect of mitomycin C injection via great omentum vein during resection of intrahepatic cholangiocarcinoma against carcinoma recurrence
HUANG Yang-qing, YANG Jia-mei*, SHEN Wei-feng
(Department of Special Treatment, Eastern Hepatobiliary Hospital, Second Military Medical University,Shanghai 200438, China)
Abstract:
Objective:To estimate the preventive effect of mitomycin C (MMC) injection via great omentum vein during resection of intrahepatic cholangiocarcinoma (IHCC) against the recurrence of IHCC. Methods: The clinical data of 73 IHCC patients, who were treated in our hospital form Jan. 2000 to Jun. 2004, were retrospectively analyzed. Thirty-eight patients were injected with 10 mg MMC via great omentum vein during operation; thirty-five patients who received no chemotherapeutic agents were taken as controls. The recurrence of the disease was followed up and was statistically analyzed. Results: Patients in the 2 groups were matchable in sex, age, viral hepatitis, liver cirrhosis, tumor diameter, tumor number, preoperative transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection therapy (PEIT), blood transfusion, portal vein or bile duct thrombus and postoperative TACE (P>0.05). Multivariate analysis showed that the recurrence was related to the number and diameter of the tumors, with the hazard ratios being 1.877(P=0.001)and 1.391(P=0.029 4),respectively; injection of MMC had no influence on the recurrence. There was no significant difference in the time of disease-free survival(DFS)between the 2 groups, with the median time of DFS of MMC injection group being 5 months and of control group being 3 months after the first operation(P=0.125 3). The recurrence rates in the MMC group and control group were 65.79% vs 68.57%(P=0.800 4) 6 months after operation, 81.58% vs 94.29%(P=0.099 0)1 year after operation, 89.47% vs 97.14% (P=1.679 55) 2 years after operation and 92.11% vs 97.14%(P=0.344 7)3 years after operation. Conclusion: Injection of 10mg MMC via great omentum vein during resection of IHCC may have no definite effect on the recurrence of IHCC; however, perspective study is needed to verify this finding.
Key words:  intrahepatic cholangiocarcinoma  hepatectomy  recurrence  greater omentum vein  mitomycin-c