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目的采用倾向值匹配法比较解剖性肝切除和非解剖性肝切除两种方法对肝细胞癌预后的影响。方法回顾性分析2010年1月至2015年12月南昌大学第一附属医院收治的124例接受肝癌切除的肝细胞癌患者的临床资料,其中解剖性肝切除组64例,非解剖性肝切除组60例。利用倾向值匹配的方法均衡组间协变量后,比较两组患者的总体生存率,并用Cox比例风险模型分析影响肝癌预后的危险因素。结果经倾向值匹配后,解剖性肝切除组(n=29)与非解剖性肝切除组(n=45)患者的中位总体生存时间分别52(44.83~59.17)个月和38(31.45~44.55)个月,组间差异有统计学意义(P=0.005)。Cox回归模型多因素分析显示解剖性肝切除有助于提高肝细胞癌患者的总体生存率(相对危险度为0.54,95%置信区间0.30~0.96,P=0.04)。结论解剖性肝切除较非解剖性肝切除更能提高肝细胞癌患者的总体生存率。
Objective To compare the effects of anatomical and non-anatomic hepatectomy on the prognosis of hepatocellular carcinoma by the propensity matching method. Methods The clinical data of 124 patients with hepatocellular carcinoma who underwent hepatectomy for hepatocellular carcinoma admitted to the First Affiliated Hospital of Nanchang University from January 2010 to December 2015 were retrospectively analyzed. Among them, 64 patients underwent anatomic liver resection and non-anatomical liver resection 60 cases. After adjusting the intergroup covariates by propensity matching method, the overall survival rate of the two groups was compared, and the risk factors of prognosis of HCC were analyzed by Cox proportional hazards model. Results After the propensity values were matched, the median overall survival of patients in anatomical group (n = 29) and non-anatomic group (n = 45) was 52 (44.83 ~ 59.17) months and 38 44.55) months, the difference between the groups was statistically significant (P = 0.005). Cox regression model multivariate analysis showed that anatomic hepatectomy could improve the overall survival of patients with hepatocellular carcinoma (relative risk 0.54,95% confidence interval 0.30 to 0.96, P = 0.04). Conclusion Anatomic liver resection can improve the overall survival rate of patients with hepatocellular carcinoma more than non-anatomical liver resection.