经肝门血管解剖和靶肝段染色引导下肝段切除术加术中灌注化疗治疗原发性肝癌

Clinical Evaluation on Hepatic Segmentectomy under Segmental Staining and Intraoperative Chemotherapy for Primary Liver Cancer by Hepatic Portal Anatomic Dissection

目的探讨肝段染色指导下肝段切除术和术中灌注化疗治疗肝癌的临床疗效。方法回顾性分析我院2001年7月～2006年10月收治的460例肝癌患者的临床资料，根据不同方法分成两组：A组210例，术中应用解剖分离肝门联合染色指导下行肝段切除术和术中灌注化疗；B组250例，行常规肝切除术。术后定期复查肝功能、AFP和影像学检查。结果A组比B组术中出血少，术后肝功能恢复快和并发症少（P〈0．05），A组3年和5年生存率分别为58．27％和31．41％，明显高于B组的42．28％和20．13％（P〈0．05）。A组1、3和5年复发率分别为20．24％，34．62％和44．20％，明显低于B组的43．21％、70．21％和89．24％（P〈0．05）。结论解剖分离肝门联合染色指导下肝段切除术和术中灌注化疗可减少术后并发症，降低术后复发率，提高患者的生存率。

Objective To explore the clinical evaluation on hepatic segmentectomy under segmental staining and intraoperative chemotherapy for primary liver cancer （ PLC ） by hepatic portal anatomic dissection. Methods The clinical data of 460 PLC patients admitted from July 2001 to October 2006 were analyzed retrospectively. 210 cases underwent hepatic segmentectomy under segmental staining and intraoperative chemotherapy by anatomic dissection （group A）, 250 cases underwent routine hepatectomy （group B）. Liver function, AFP and radiographic examination were regularly used after surgery. Results There were significant differences between two groups with respect to intraoperative blood loss, postoperative liver function and postoperative complications （P 〈 0.05 ）, group A was better than group B. The overall 3- and 5-year survival rates in group A were 58. 27% and 31.41% respectively, which were significantly higher than those of group B （42.28% and 20. 13%, P 〈 0.05）. The local recurrence rates of 1-, 3- and 5-year in group A were 20. 24%, 34.62% and 44.20% respectively, which were significantly lower than those of group B（43.21%, 70.21% and 89.24%, P 〈0.05）. Conclusions The hepatic segmentectomy under segmental staining and intraoperative chemotherapy for PLC by hepatic portal anatomic dissection may reduce postoperative complications, lower postoperative relapse rates and prove survival rates.