精准肝切除治疗原发性肝癌的临床疗效

Clinical efficacy of precise hepatectomy in patients with primary hepatic carcinoma

目的探讨精准肝切除治疗原发性肝癌的临床疗效。方法 100例原发性肝癌患者均分精准肝切除(A)组和传统肝切除(B)组。A组术前行CT三维重建及计算机辅助方案制定,术中超声精准定位,行半肝入肝血流阻断;B组仅术中采用Pringle法行全肝入肝血流阻断。比较两组临床相关指标。结果与B组比较,A组手术时间长[(174.6±41.9)min vs.(254.8±29.8)min]、肛门排气时间和住院时间短[(83.6±6.5)min vs.(74.6±5.2)min和(17.1±2.3)d vs.(14.3±1.4)d]、术中出血量和腹腔引流量少[(654.2±196.1)ml vs.(487.1±119.4)ml和(784.1±150.3)ml vs.(648.2±114.5)ml]、术后1周ALT峰值和术后并发症发生率低[(495.1±291.1)U/L vs.(356.8±162.6)U/L和26%vs.10%](P<0.05)。结论与传统肝切除方案比较,精准肝切除治疗原发性肝癌安全,效果较好。

Objective To explore the clinical efficacy of precise hepatectomy in patients with primary hepatic carcinoma （PHC）. Methods One hundred patients with PHC were equally divided into groups of A（treated with precise hepatectomy） and B（treated with conventional hepatectomy）. CT 3-dimentional reconstruction and computer-assisted plan before operation were conducted in group A, in which precisely ultrasonic localization and hemihepatie vascular occlusion were carried out during operation. Total hepatic vascular occlusion was conducted by Pringle way in group B. Clinically relevant indicators in two groups were analyzed. Results Compared with group B,operative time was longer in group A[ （174.6 ±41.9） min vs. （254. 8 ±29.8） mini, the time of anus exhausting and hospital stay were shorter in group A[（83.6＋-4-_6.5） min vs. （74.6±5.2） min and （17. ±2. 3） d vs. （14. 3 ±1.4） d], blood loss and abdominal drainage during operation were less in group A[（654. 2 ± 196.1） ml vs. （487. 1±119.4） ml and （784. 1±150.3） ml vs. （648.2±114.5） roll,peak of ALT on the 7th day and incidence rate of complication after operation were lower in group A[（495.1 ±291.1） U/L vs. （356. 8± 162. 6） U/L and 26% vs. 10%）] （P〈0. 05）. Conclusion Precise hepatectomy is safer and more effective than conventional hepatectomy in the treatment of PHC.