可切除肝癌术前经肝动脉化学药物栓塞对肝切除手术的影响

Influence of preoperative transcatheter arterial chemoembolization on liver resection in patients with resectable hepatocellular carcinoma

目的探讨可切除肝癌术前经肝动脉化学药物栓塞对肝切除手术的影响。方法回顾分析了自 1996年 1月至 1997年 1月收治的 12 6例患者 ,术前经肝动脉化学药物栓塞组 (TACE组 )6 2例 ,术前未经肝动脉化学药物栓塞组 6 4例。对比 2组手术前后肝功能指标变化 ,手术所见 ,肝门阻断时间 ,术中平均出血量 ,平均手术时间 ,术后 1、2、3d腹腔引流量 ,手术死亡率及并发症发生情况。结果 2组手术前后肝功能改变无差异 ,2组均无手术死亡。手术中发现术前TACE组胆囊壁增厚、萎缩、粘连及癌灶与膈肌、侧腹壁和网膜粘连远比非TACE组多。TACE组肝硬化加重 ,手术时间延长 ,术中失血量及术后 1、2、3d腹腔引流量多 ,2组之间手术并发症差异无显著意义。结论术前TACE使手术难度及危险性增加 。

ObjectiveTo study the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepatocellular carcinoma (HCC).MethodsTACE was performed before liver resection in 62 out of 126 patients, and perioperative risk factors were compared with that of the 64 patients without TACE including liver perioperative function alterations, average blood loss during operation, the average time of clamping porta hepatis and operation, abdominal drainage at 1-, 2-, and 3-days post-op, mortality and morbidity. ResultsThere was not significant difference in liver function alteration in the two groups, there was no mortality in the two groups. Liver cirrhosis in TACE group was more serious than that in no TACE group, the operation time was longer in TACE group. Blood loss, and abdominal drainage were much more in TACE group than in no TACE group. However postoperative complications did not differ.Conclusion Preoperative TACE for resectable HCC increases surgical difficulty and risk. Preoperative TACE for resectable HCC needs to be used on baseis of strict selection.