陆军军医大学学报2026，Vol.48Issue(5)：583-591,9.DOI:10.16016/j.2097-0927.202512147
全凭静脉与静吸复合麻醉对肝癌根治术后患者生存率影响总体无差异但特定亚组风险增高:一项回顾性队列研究
摘要
Abstract
Objective To investigate the impact of propofol-based total intravenous anesthesia(TIVA)versus sevoflurane-propofol intravenous-inhalation combined anesthesia(IICA)on 5-year postoperative survival rates in patients undergoing radical hepatectomy for hepatocellular carcinoma(HCC).Methods A retrospective cohort study was conducted on the clinical and follow-up data from 504 patients undergoing radical HCC surgery in our hospital between January 2015 and December 2017.According to different anesthesia techniques,the patients were divided into a IICA groups(n=176)and a TIVA group(n=328).The 5-year postoperative survival rates were compared between the 2 groups of patients.Stratified analyses were carried out by age,tumor size and number,Child-Pugh class and model for end-stage liver disease(MELD)score,presence of portal vein tumor thrombus(PVTT),intraoperative transfusion,hepatitis B surface antigen status,alpha-fetoprotein(AFP),tumor node metastasis(TNM)stage,and Barcelona clinic liver cancer(BCLC)stage to compare the impact of the 2 anesthesia methods on postoperative survival rates in subgroups.Results Among the cohort,the median 5-year survival was 33.00(14.25 to 60.00)months in the TIVA group with 212 deaths(64.60%),and 27.00(11.00 to 60.00)months in the IICA group with 125 deaths(71.00%).There was no statistically significant difference in 5-year survival rate between groups(HR=1.27,95%CI:0.96 to 1.67,P>0.05).Stratified analysis revealed significant increased 5-year mortality risk with CIVA in subgroups with MELD score>7.24(HR=1.61,95%CI:1.11 to 2.32,P=0.011),BCLC stage B(HR=1.74,95%CI:1.11 to 2.71,P=0.015),absence of PVTT(HR=1.35,95%CI:1.04 to 1.74,P=0.026),and no intraoperative transfusion(HR=1.34,95%CI:1.02 to 1.75,P=0.034).Conclusion Among patients undergoing radical hepatectomy for HCC,there is no difference in 5-year overall survival between propofol-based TIVA and sevoflurane-propofol IICA.However,IICA is associated with significantly increased 5-year mortality risk in specific subgroups:MELD score>7.24,absence of PVTT,BCLC stage B,and no intraoperative transfusion.关键词
丙泊酚/七氟烷/全凭静脉麻醉/肝癌/生存率Key words
propofol/sevoflurane/total intravenous anesthesia/hepatocellular carcinoma/survival rate分类
医药卫生引用本文复制引用
邱卓敏,李鑫雨,高宪,张宁,文静,王顺宏,李小东,陈志宇,甯交琳..全凭静脉与静吸复合麻醉对肝癌根治术后患者生存率影响总体无差异但特定亚组风险增高:一项回顾性队列研究[J].陆军军医大学学报,2026,48(5):583-591,9.基金项目
国家自然科学基金面上项目(82270095) Supported by the General Program of National Natural Science Foundation of China(82270095). （82270095）
