【摘要】 目的探讨精准肝切除在原发性肝癌(肝癌)中的应用价值。方法回顾性分析2011年1月至2014年12月在中山市人民医院行肝切除术的60例肝癌患者临床资料。根据手术方式分为精准肝切除术组(精准组)和传统肝切除术组(传统组)。其中精准组30例,男18例,女12例;年龄25~60岁,中位年龄45岁。传统组30例,男20例,女10例;年龄23~62岁,中位年龄46岁。所有患者均签署知情同意书,符合医学伦理学规定。精准组采用选择性入肝血流阻断,利用缺血界线及肝静脉主支作为引导标志确定肝离断平面,中心静脉压控制在5 cm H2O(1 cm H2O=0.098 k Pa)以下,超声刀离断肝组织,肝断面不予对拢缝合。传统组采用Pringle法阻断第一肝门血流,采用血管钳夹法快速离断肝组织,术后对拢缝合肝脏断面。观察两组患者的手术时间、术中出血量、术后7 d肝功能指标的变化、术后住院时间及术后并发症。两组资料的比较采用t检验,率的比较采用χ2检验。结果所有患者均完成肝切除术,肿瘤切除后切缘均为阴性,围手术期无患者死亡。精准组患者平均手术时间为(302±47)min,明显长于传统组的(209±30)min(t=4.016,P<0.05)。精准组术中出血量为(354±71)ml,明显少于传统组的(598±109)ml(t=-2.376,P<0.05)。精准组患者术后7 d的ALT、AST、TB分别为(80±36)U/L、(61±18)U/L、(29±6)μmol/L,明显低于传统组的(252±55)U/L、(233±62)U/L、(49±8)μmol/L(t=-2.173,-1.640,-2.240;P<0.05)。精准组患者术后住院时间为(13±3)d,明显短于传统组的(22±5)d(t=-2.045,P<0.05)。精准组患者术后并发症发生率为7%(2/30),明显低于传统组的27%(8/30)(χ2=4.320,P<0.05)。结论与传统肝切除相比,精准肝切除具有术中出血少、术后肝功能恢复快、并发症发生率低、术后康复快、住院时间短的优势。更多还原

【Abstract】 Objective To evaluate the application value of precise hepatectomy in primary liver cancer(liver cancer). Methods Clinical data of 60 patients with liver cancer undergoing hepatectomy in Zhongshan People’s Hospital between January 2011 and December 2014 were retrospectively analyzed. According to the surgical procedures, all patients were divided into the precise hepatectomy group(precise group) and traditional hepatectomy group(traditional group). In the precise group, 30 patients were included, 18 males and 12 females, aged between 25 and 60 years with a median age of 45 years. In the traditional group, 30 patients were included, 20 males and 10 females, aged between 23 and 62 years with a median ageof 46 years. The informed consents of all patients were obtained and the local ethical committee approval was received. In the precise group, selective hepatic blood inflow occlusion was performed. The liver transection plane was determined according to the ischemic boundary and main branch of hepatic vein. The central venous pressure was controlled below 5 cm H2O(1 cm H2O=0.098 k Pa). The liver tissues were separated by ultrasonic scalpel. The liver section planes were left without suture. In the traditional group, Pringle maneuver was performed to occlude the blood flow of porta hepatis. The liver tissues were rapidly separated by vascular clamping. The liver section planes were sutured after surgery. The operation time, intraoperative hemorrhage volume, changes of liver function indexes at postoperative 7 d, postoperative length of hospital stay and postoperative complications were observed between two groups. Data of two groups were compared using t test and the ratio was compared using Chi-square test. Results Hepatectomy was successfully completed in all patients. The incisional margin was detected as negative after tumor resection. No patients died during perioperative period. In the precise group, the mean operation time was(302±47) min, significantly longer compared with(209±30) min in the traditional group(t=4.016, P<0.05). In the precise group, intraoperative hemorrhage volume was(354±71) ml, significantly less than(598±109) ml in the traditional group(t=-2.376, P<0.05). In the precise group, the alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin(TB) at postoperative 7 d were(80±36) U/L,(61±18) U/L and(29±6) μmol/L, significantly lower than(252±55) U/L,(233±62) U/L and(49±8) μmol/L in the traditional group(t=-2.173,-1.640,-2.240; P<0.05). In the precise group, postoperative length of hospital stay was(13±3) d, significantly shorter compared with(22±5) d in the traditional group(t=-2.045, P<0.05). The incidence of postoperative complications in the precise group was 7%(2/30), significantly lower than 27%(8/30) in the traditional group(χ2=4.320, P<0.05). Conclusion Compared with traditional hepatectomy, precise hepatectomy has the advantages of less intraoperative hemorrhage, faster postoperative recovery of liver function, lower incidence of complications, faster postoperative recovery and shorter length of hospital stay.更多还原