前入路绕肝提拉法对右半肝切除术中中心静脉循环肿瘤细胞的影响

Monitoring of the generation of circulating tumor cells in central venous blood of patients undergoing right hepatectomy using anterior liver hanging maneuver

目的:探讨前入路绕肝提拉法右半肝切除对术中肿瘤细胞释放的影响.方法:选择2008-01/2011-06我院收治的拟行右半肝切除患者40例,随机分为常规肝切除组和前入路绕肝提拉法肝切除组,分别于手术开始前(切皮前)、术中离断肝实质之前(前入路绕肝提拉法组为分离肝后隧道、安置绕肝带、分离结扎右侧肝动脉和门静脉后;常规肝切除组为游离肝周韧带,Pringle法阻断第一肝门后)、肝肿瘤切除后3个时间点,自中心静脉置管处抽取血样,行循环肝源性细胞检测.比较两组患者中在各时间点检测结果阳性患者的比例.结果:前入路绕肝提拉法组和常规法组术前检测结果阳性患者比例无显著差异(2/18vs1/19,P>0.05).术中肝切除前,前入路绕肝提拉法组中心静脉血样肝源性细胞检测结果阳性患者显著少于常规法组(20%vs55%,P=0.022);肝肿瘤切除后,前入路绕肝提拉法组中心静脉血样肝源性细胞检测结果阳性患者亦显著少于常规法组(40%vs80%,P=0.010).结论:前入路绕肝提拉法较常规法肝切除可减少术中肿瘤细胞的血源性播散,理论上减少了肝癌术中肿瘤细胞医源性播散,降低了术后转移复发的风险.

AIM：To monitor the generation of circulating tumor cells in central venous blood of patients undergoing right hepatectomy using anterior liver hanging （ALH） maneuver.METHODS：From January 2008 to June 2011,40 patients undergoing right hepatectomy were randomly allocated to ALH and conventional approach （CA） groups.Blood samples were collected from all patients through a central venous catheter,just before skin incision,just before parenchymal transection （after hilar dissection in the ALH group and after mobilization of the liver in the CA group）,and after delivery of the tumor.All samples were detected for CTCs using an asialoglycoprotein receptor-based isolation strategy.The proportions of CTC-positive patients at various stages of surgery were compared between the two groups.RESULTS：The proportion of CTC-positive patients showed no significant difference before surgery between the two groups （2/18 vs 1/19,P 0.05） but was significantly lower in the ALH group than in the CA group before parenchymal transection and at the end of surgery after delivery of the tumor （20% vs 55%,40% vs 80%;P=0.022,0.010）.CONCLUSION：Right hepatectomy using anterior liver hanging maneuver can reduce intraoperative blood-borne spread of tumor cells compared with the conventional method.