经前入路和后入路切除右叶大肝癌手术及近期疗效比较

Right hepatectomy for huge hepatic carcinoma, anterior or posterior approach

目的比较经前入路和后入路法切除右叶大肝癌手术的近期疗效。方法1996年10月至2004年12月间在我院共为78例右叶大肝癌患者施行肝切除术，2002年9月前共对37例这类患者采用传统的后入路方法行肝切除术（A组），2002年以后对其余41例均采用前入路法手术（B组）。对两种手术方法术中失血量、输血量、围手术期死亡率进行分析。结果B组患者术中失血量（2．11±0．42）L明显少于A组（3．27±0．33）L（t=-2．129，P〈0．05）；B组输血量（1．31±0．34）L明显少于A组（2．64±0．37）L（t=-2．637，P〈0．01）；B组患者住院死亡率（2．4％）与A组（16．2％）比较差异有统计学意义（x^2=4．519，P〈0．05）。结论前入路法是右叶大肝癌手术切除的首选方法，其手术及近期疗效比传统的后入路法有较好的临床效果。

Objective To compare anterior approach （AA） with conventional posterior approach （CPA） for right hepatectomy in patients with huge hepatic carcinoma. Methods Right hepatectomy were undertaken on 78 consecutive patients with large right hepatic cancer from October 1996 to December 2004. Among them, 57 right hepatectomy were performed by CPA method before September 2002 （ Group A）, 41 patients underwent hepatectomy through AA since 2002 （ Group B）. The individual mean volume of blood loss and blood transfusion during operation and the rate of hospital death in Group A were compared with those in Group B retrospectively. Results The median intraoperative blood loss in Group B （2. 11 ± 0.42） L was significantly less than that in Group A （5. 27 ±0. 55） L （t = -2. 129,P 〈0. 05） ; The median volume of intraoperative blood transfusion in Group B （1.51 ±0. 54） L was also significantly less than that in Group A （ 2. 64 ± 0. 37 ） L （ t = - 2. 637, P 〈 0. 01 ）. The hospital mortality rate in Group B （ 2.4% ） was significantly lower than that in Group A （ 16. 2% ） （ x^2 = 4. 519,P 〈 0.05 ）. Conclusions AA is the method of choice in performing right hepatectomy for patients with large right hepatic cancer.