【摘要】 目的 验证再次肝切除术在原发性肝癌（简称肝癌）术后复发患者中的有效性，并探究影响术后疗效的因素。方法 回顾性收集2008年1月至2019年6月北京大学人民医院肝胆外科因初次肝切除术后肝癌复发而再次行肝切除术的肝癌患者（再次肝切除组，n=50）的临床资料，并收集同期因肝癌术后复发行射频消融治疗（消融组，n=48）、同期行初次肝切除术治疗（初次肝切除组，n=50）且一般资料相近的肝癌患者作为对照，探究再次肝切除术的有效性及安全性；并通过Cox多因素分析探究再次肝切除术后患者预后的影响因素。结果 与初次肝切除组比较，再次肝切除组无瘤生存时间（18.5个月vs 24.1个月，χ2=0.111,P=0.560）差异无统计学意义。但与消融组比较，再次肝切除组的无瘤生存时间（18.5个月vs14.2个月，χ2=4.403,P=0.040）及总体生存时间（25.8个月vs 21.2个月，χ2=4.487,P=0.032）均更长。单因素分析结果显示肿瘤复发时间（P=0.021）、有无卫星灶（P=0.022）、微血管侵犯（P=0.033）及肿瘤分化程度（P=0.039）是再次肝切除患者无瘤生存时间的影响因素，而Child-Pugh分级（P=0.030）、肿瘤复发时间（P=0.032）、微血管侵犯（P=0.021）是再次肝切除患者总体生存时间的影响因素。Cox多因素分析显示，肿瘤复发时间（P=0.012）、微血管侵犯（P=0.046）及卫星灶（P=0.050）是再次肝切除患者无瘤生存时间的独立危险因素，Child-Pugh分级（P=0.015）和肿瘤复发时间（P=0.015）是再次肝切除患者总体生存时间的独立危险因素。结论 肝癌术后复发再次肝切除术的有效性与首次肝切除术相仿，能够改善肝癌复发患者的预后；而肿瘤复发时间、微血管侵犯及卫星灶是再次肝切除患者无瘤生存时间的独立预测因素，ChildPugh分级和肿瘤复发时间是再次肝切除患者总体生存时间的独立预测因素。更多还原

【Abstract】 objective To evaluate the therapeutic effect of repeat hepatectomy in patients with recurrent liver cancer, and to explore the factors that affect postoperative efficacy. Methods The clinical data of patients liver cancer, who admitted in Peking University People’s Hospital from Jan. 2008 to Jun. 2019, was retrospectively collected, 50 patients received repeat hepatectomy for recurrent liver cancer(repeat hepatectomy group), 48patients received radiofrequency ablation for recurrent liver cancer(ablation group), and 50 patients received initial hepatectomy for primary liver cancer(initial hepatectomy group), patients in above 3 groups had similar general characteristics. The effectiveness and safety of repeat hepatectomy were explored. Cox multivariate analysis was used to investigate the factors affecting the prognosis in patients after repeat hepatectomy. Results There was no statistically significant difference in the disease-free survival time between the repeat hepatectomy group and the initial hepatectomy group(18.5 months vs 24.1 months, χ~2=0.111, P=0.560). However, the diseasefree survival time(18.5 months vs 14.2 months, χ~2=4.403, P=0.040) and overall survival time(25.8 months vs 21.2 months, χ~2=4.487, P=0.032) in the repeat hepatectomy group were both significantly longer than those in the ablation group. Univariate analysis showed that, for patients with repeat hepatectomy, tumor recurrence time(P=0.021), satellite nodules(P=0.022), microvascular invasion(P=0.033), and tumor differentiation degree(P=0.039) were the influencing factors for disease-free survival time, while Child-Pugh grade(P=0.030), tumor recurrence time(P=0.032), and microvascular invasion(P=0.021) were the influencing factors for overall survival time. Cox multivariate analysis showed that, for patients with repeat hepatectomy, tumor recurrence time(P=0.012), microvascular invasion(P=0.046), and satellite nodules(P=0.050) were independent risk factors for disease-free survival time, Child-Pugh grade(P=0.015) and tumor recurrence time(P=0.015) were independent risk factors for overall survival time. Conclusion Repeat hepatectomy for recurrent liver cancer is as effective as the initial hepatectomy, which can improve the prognosis of patients with recurrent liver cancer. Tumor recurrence time, microvascular invasion, and satellite nodules are independent predictors for disease-free survival time, while Child-Pugh grade and tumor recurrence time are independent predictors for overall survival time.更多还原