前入路右半肝切除术与传统右半肝切除术治疗大肝癌的对比观察

A comparative study of anterior versus conventional approach right hepatectomy for large hepatocellular carcinoma

目的 研究前入路右半肝切除术与传统右半肝切除术治疗大肝癌的效果.方法 回顾性分析中山大学附属第一医院近4年来行右半肝切除术治疗的原发性肝细胞癌（HCC）188例,其中前入路右半肝切除术92例（前入路组）,传统右半肝切除术96例（传统组）,比较两组患者的临床病理和生存资料.结果 本组手术死亡5例（2.7%）,其中前入路组2例,传统组3例.两组的临床生化指标、肿瘤病理指标（除肿瘤平均直径外）比较差异均无统计学意义.前入路组术中平均出血量、大出血（≥3000 ml）的病例数和需要输血的病例数均显著少于传统组.前入路组术后1,3年无瘤生存率分别为56.2%、30.9%,显著高于传统组的39.1%、13.0%,P=0.043.前入路组术后1,3年的累积生存率分别为75.8%、45.9%,也明显高于传统组的52.1%和9.7%,P=0.002.Cox风险比例模型显示肿瘤大小[P=0.014,危险度（OD）=1.074]和手术方式（P=0.009,OD=0.468）是影响HCC右半肝切除术后无瘤生存率的独立危险因素.手术方式（P=0.003,OD=0.369）是影响术后累积生存率的独立危险因素.结论 前入路右半肝切除术可显著减少术中出血,术后无瘤生存率和累积生存率均高于传统右半肝切除术.

Objective To compare the outcomes between anterior versus conventional approach right hepatectomy for large hepatocellutar carcinoma（HCC）.Methods A total of 188 consecutive patients with large HCC（≥5 cm）undergoing right hepatectomy were reviewed retrospectively.Among them,92patients received anterior approach right hepatectomy（anterior group）while the other conventional right hepatectomy（conventional group）.Their clinicopathologic data and survivals were compared.Results There were five surgical deaths（2.7%）,two in the anterior group and three in the conventional group.The biochemical and tumor pathological data（except for tumor size） of these two groups were comparable.The mean intranperative blood loss,the number of patients with massive hemorrhage（〉3000ml）and the volume of blood transfusion of the anterior group were markedly less than those of conventional group.The 1-,3-year disease-free survival rates of the anterior group were significantly better than those of the conventional group anterior group were also markedly higher than those of conventional group.The Cox regression model indicated that tumor size[P=0.014,odd ratio（OD）：1.074] and surgical procedure（P：0.009,OD=0.468） were independent risk factors correlated with disease-free survival.And the surgical procedure（P=0.003,OD=0.369） was the only independent risk factor for postoperative cumulative survival.Conclusion Anterior approach right hepatectomy can significantly decrease intraoperative blood loss.The postoperative survivals of large HCC patients are significantly improved by anterior approach right hepatectomy.