应用精细肝脏外科理念治疗原发性肝癌53例

Treatment of primary liver cancer by precise liver surgery:an analysis of 53 cases

目的:评价应用精细肝脏外科理念治疗原发性肝癌的价值.方法:回顾性分析我院2008-08/2009-11行肝切除的125例原发性肝癌患者临床资料,其中采用精细肝切除术(精细肝切除组)53例,传统肝切除术(传统肝切除组)72例.比较两组手术时间、术中出血量及输血率、切缘癌残留率、住院时间、住院费用、术后肝功能、并发症发生率,以及术后1年肿瘤复发率和1年生存率.结果:精细肝切除组与传统肝切除组相比,手术时间延长(233.2min±90.2minvs138.4min±42.0min,P<0.05),术中出血量和输血例数、住院费用均无显著差异(P>0.05).但切缘癌残留率低(1.9%vs13.9%,P<0.05),住院时间短(12.2d±2.1dvs14.7d±3.5d,P<0.05),术后丙氨酸氨基转移酶(454.8U/L±127.4U/Lvs714.6U/L±216.4U/L,P<0.05)、总胆红素水平低(25.3μmol/L±8.0μmol/Lvs33.0μmol/L±10.0μmol/L,P<0.05),术后并发症发生率低(9.4%vs23.6%,P<0.05).34例随访1年以上,术后1年肿瘤复发率低(8.3%vs40.9%,P<0.05),1年生存率未显示明显差异(P>0.05).结论:应用精细肝脏外科理念治疗原发性肝癌安全有效,相比传统的肝切除具有明显的优势.

AIM：To evaluate the efficacy of precise liver surgery in the treatment of primary liver cancer （PLC）.METHODS：The clinical data of 125 PLC patients who underwent hepatectomy at our hos-pital from August 2008 to November 2009 were retrospectively analyzed.Precise hepatectomy was performed in 53 patients and traditional hepatectomy in 72 patients.The operative time,operative blood loss,blood transfusion rate,margin-positive rate,hospital stay,hospitalization expense,postoperative liver function,postoperative complications,recurrence rate,and survival rate were compared between the two groups of patients.RESULTS：Compared with the traditional hepatectomy group,the precise hepatectomy group had lower levels of postoperative alanine aminotransferase and postoperative total bilirubin,shorter hospital stay,less postoperative complications,longer operative time,lower marginpositive rate and lower tumor recurrence rate （454.8 U/L ± 127.4 U/L vs 714.6 U/L ± 216.4 U/L,P 0.05;25.3 μmol/L ± 8.0 μmol/L vs 33.0 μmol/L ± 10.0 μmol/L,P 0.05;12.2 d ± 2.1 d vs 14.7 d ± 3.5 d,P 0.05;9.4% vs 23.6% P 0.05;233.2 min ± 90.2 min vs 138.4 min ± 42.0 min,P 0.05;1.9% vs 13.9%,P 0.05;8.3% vs 40.9%,P 0.05）.No significant difference was found in operative blood loss,blood transfusion rate,hospitalization expense and one-year survival rate between the two groups （all P 0.05）.CONCLUSION：Precise liver surgery is more safe and effective than traditional liver surgery in the treatment of PLC.