肝癌解剖性与非解剖性切除对患者术后近期病死率的影响

The impact of anatomic and non-anatomic liver resection on early mortality in patients with hepatocellular carcinoma: a prospective study

目的探讨肝癌解剖性切除与非解剖性切除对患者术后近期病死率的影响,并分析肝癌切除术后与近期死亡相关的因素。方法 2006年8月—2009年1月,笔者行肝癌根治性切除52例,随机分为两组,甲组25例,采用解剖性肝癌切除术;乙组27例,采用非解剖性肝癌切除术。随访患者术后存活时间。结果解剖性切除组1年病死率20.0%,非解剖性切除组1年病死率25.9%,两组间近期并发症发生人次及病死率无明显差异;但解剖性切除组术中出血量较非解剖性切除组少(P=0.006)。单因素分析和多因素分析提示,肝癌门静脉癌栓与近期病死率有关(P=0.019)。结论肝癌解剖性切除与非解剖性切除对患者术后近期病死率无明显影响,肝癌门静脉癌栓可以成为预测术后早期死亡的主要因素。[中国普通外科杂志,2011,20(1):23-26]

Objective To compare the impact of the type of resection（anatomic versus non-anatomic） on early mortality in patients with hepatocellular carcinoma（HCC） and to explore factors related to early mortality in patients after resection of hepatic tumor.Methods Fifty-two patients with similar clinico-pathologic data were randomaly divided into 2 groups for curative liver resection for HCC,25 patients underwent anatomic resection of at least one liver segment（group A） and 27 patients underwent non-anatomic resection（group B）.We compared the age,gender,HbsAg,preoperative serum albumin,alpha-fetoprotein（AFP）,postoperative pathologic diagnosis,TNM stage,tumor size,portal vein tumor thrombosis,duration of hospital stay and follow-up in the two groups.Results The one year mortality was 20.0% in anatomic resection group and 25.9% in non-anatomic resection group.No significant difference was detected in early mortality and complications between the 2 groups.The blood loss during operation of anatomic resection group was less than that of non-anatomic resection group（P=0.006）.Factor contributing to early mortality was presence of portal vein tumor thrombosis（P=0.019）.Conclusions There is no significant difference in early mortality between anatomic and non-anatomic liver resection.The presence of portal vein tumor thrombosis could be a major factor to predict early mortality.