原发性肝癌合并肝硬化手术方法的探讨

Discussion on Surgical Method of Primary Liver Cancer with Liver Cirrhosis

【目的】探讨原发性肝癌合并肝硬化患者采用不阻断入肝血流的肝叶切除术的，临床效果。【方法】本院2007年9月至2012年9月收治原发性肝癌合并肝硬化患者286例，随机分为观察组和对照组各143例，对照组采用分支入肝血流阻断切除术，观察组采用不阻断入肝血流切除术。【结果】两组术中出血量、手术时间无明显差异（P〉0．05）。术前及术后1d两组谷丙转氨酶（ALT）及总胆红素水平（TB）无明显差异（P〉0．05），术后7d对照组均显著高于观察组，差异有统计学意义（P〈0．05）。术后切口感染、腹水、上消化道出血、肺部感染、胆漏为主要并发症，对照组并发症发生率为19．6％，观察组为7．7％，观察组显著少于对照组（P〈0．05）。【结论】采用不阻断入肝血流的肝叶切除术治疗原发性肝癌合并肝硬化具有一定的安全性和可行性，降低了并发症发生率，对肝功能影响较小，值得在临床推广应用。

[Objective] To explore the clinical efficacy of hepatolobectomy without interrupting liver flow for the treatment of primary liver cancer with liver cirrhosis. [Methods]Totally 286 cases of primary liver cancer with liver cirrhosis admitted to our hospital from Sept. 2007 to Sept. 2012 were randomly divided into observation group and control group with 143 in each. The control group underwent liver resection with inter- rupting the branch of liver flow, while the observation group underwent liver resection without interrupting liver flow. [Results]There was no obvious difference in intraoperative blood loss and operation time between two groups（ P ~0.05）. There was no obvious difference in alanine aminotransferase（ALT） and total bilirubin （TB） between before operation and ld after operation, but those in control group 7d after operation were markedly higher than those in observation group, and there was significant difference（ P d0.05）. The inci- dence of complications such as incision infection, ascites, upper gastrointestinal bleeding, lung infection and biliary fistula in observation group after operation was significantly lower than that in con：trol group（7.7 ~ vs. 19.6%, P d0.05）. [Conclusion] Liver resection without interrupting liver flow for the treatment of liver cancer with liver cirrhosis has certain safety and feasibility, and can reduce the incidence of complications with less effect on liver function, so it is worthy of clinical promotion and application.