解剖性与非解剖性肝切除治疗肝细胞癌的疗效比较研究

Comparative Study on Therapeutic Effect between Anatomical Liver Resection and Nonanatomical Liver Resection for Hepatocellular Carcinoma Patients

目的比较解剖性与非解剖性肝切除术治疗肝细胞癌(HCC)的近期和远期临床疗效及安全性。方法 138例肝切除术治疗HCC患者随机分为解剖性肝切除术组(n=76)和非解剖性肝切除术组(n=62),对2组患者的手术时间、术中出血量、输血百分率、住院时间、术后并发症发生率和术后1年总的生存率和无瘤生存率等指标进行对比研究。结果 2组患者均无围手术期死亡,手术时间、术中出血量、输血百分率、住院时间和术后并发症发生率两组间差别无统计学意义。解剖性肝切除术组标本切缘满意率(>2cm)较高,术后1年肿瘤复发率解剖性肝切除术较非解剖性肝切除术组显著降低(P=0.013),术后1年无瘤生存率解剖性肝切除术组较非解剖性肝切除术组延长(P=0.029)。结论解剖性肝切除术是治疗HCC安全、可行和有效的术式。对有适应证的病例应尽可能行解剖性肝切除术,以获得相对较好的疗效和较高的安全性。

Objective To compare the short-term and long-term clinical therapeutic effect and safety between anatomical liver resection and nonanatomical liver resection for hepatocellular carcinoma（HCC） patients.Methods One hundred and thirty eight patients with hepatocellular carcinoma underwent liver resection were randomly divided into anatomical liver resection group（n=76） and nonanatomical liver resection group（n=62）.Operative time,the volume of intraoperative blood loss and the rate of blood transfusion,length of hospital stay and the rate of postoperative complication,liver function recovery,recurrence and survival rate in one year after liver resection were compared between the two groups.Results No perioperative death was found in both groups.There were no significantly statistical differences in operative time,the volume of intraoperative blood loss,the rate of blood loss transfusion,postoperative complication and lenght of hospital stay between two groups（P0.005）.The rate of satisfactory resection margin（2 cm） of anatomical liver resection was higher than that of nonanatomical liver resection（P0.005）.The rate of one year-recurrenc of tumor in anatomical liver resection was lower than that in nonanatomical liver resection（P0.005）.The rate of disease-free survival in one year after liver resection in anatomical resection group was higher than that in nonanatomical resection group.Conclusion Anatomic liver resection is safe and effective,and it is more suitable than nonanatomic liver resection for the hepatocellular carcinoma patients with operative indications.