肝门部肿瘤超声切除的临床研究

CLINIC STUDY ON THE HEPATOCELLULAR CARCINOMA NEAR PORTA HEPATIS RESECTED BY ULTRASONIC DISSECTION

目的 :对超声肝切除技术 (USD)在肝门部肿瘤切除中的应用进行临床研究和探讨。方法 :自 1991年 4月～ 1999年 3月 ,行超声肝切除术的肝门部原发肝癌患者 75例 (T组 ) ,同期 81例肝门部肝癌患者行常规肝切除手术 (C组 )。两组患者的年龄、性别分布及肝功能状况等主要临床资料无显著差异。对两组手术切除率、平均手术时间、住院死亡率、平均出血量和输血量、平均留院时间、并发症发生情况以及 1,3年生存率进行比较 ,评估手术技术的影响。结果 :两组患者均未出现手术死亡或术后住院死亡。T组手术切除率较C组有显著提高。T组的平均手术时间 (15 0± 10 .5min)明显少于C组 (2 36± 17.8min ,P <0 .0 1) ;T组的平均出血量(4 2 1± 13.1ml)和输血量 (36 4± 15 .9ml)与C组 (分别为 70 6± 2 3.0ml,5 48± 19.3ml)相比较有显著差异 (P <0 .0 1) ;平均留院时间T组 (8.2± 0 .47d)较C组 (14.1± 0 .6 0d)明显缩短 (P <0 .0 1) ,T组总并发症发生也较C组显著减少。统计显示 ,T组患者 1,3年生存率较C组显著提高 (P <0 .0 1)。结论 :超声肝切除技术由于可以选择性地暴露肝内管道组织 ,为肝门部肿瘤、大肝癌 ,尤其是侵犯大血管或胆道的肿瘤切除提供了一项新的途径。

Objective:To make a retrospective analysis of 75 patients with hepatocellular carcinoma near porta hepatis resected by the Ultrasonic dissection (USD). Methods:Of 156 patients assessed between 1991 and 1999,75 were resected by the USD (T group) and 81 resected by routine hepatectomy (C group).There was no difference in age,sex,liver function between two groups.The time of operation,hospital mortality,intraoperative blood loss and input,liver complications and survival rate of 1 and 3 years were employed to evaluate the result of USD.Results: Hospital mortality was 0 in two groups.The resective rate of T group was much higher than that of C group.The time of operation in group T (150±10.5min)was longer than that of group C(236±17.8min, P <0.01);As well,intraoperative blood loss and input of group T were less (421±13.1ml vs 706±23.0ml,364±15.9ml vs 548± 19.3 ml, P <0.01).In group T,complications occurred in 15/75,much less that that of group C.Furthermore,postoperative length of stay has been significantly reduced by USD (8.2±0.47d vs 14.1±0.60d, P <0.01).The difference in survival rate of 1 and 3 years between two group was indistinctive too ( P <0.01).Conclusions:In summary,USD has significantly reduced intraoperative blood loss and hence reduced the number of intraoperative transfusion,incidence of postoperative complications and postoperative length of stay.USD could be routinely employed in patients with hepatocelluar carcinoma near porta hepatis or major carcinoma since it provides more superiority and selection.