不同入肝血流阻断方案对肝细胞癌合并肝硬化手术患者疗效和安全性的对比

Contrast of efficacy and safety of different hepatic inflow occlusion method for patients with hepatocellular carcinoma and cirrhosis surgery

目的比较分析不同入肝血流阻断方案对肝细胞癌合并肝硬化手术患者疗效和安全性的对比。方法选取2010年1月～2013年9月广东省高州市人民医院肝细胞癌合并肝硬化手术患者80例,根据入肝血流阻断方法分为对照组（全肝入肝血流阻断法）（Pringle法）和观察组（半肝入肝血流阻断法）,每组各40例。分别比较两组患者的手术时间、术中出血量、术后住院时间、血清谷丙转氨酶（ALT）、总胆红素（TBIL）等肝功指标的水平以及安全性。结果观察组手术时间[（160±75）min]、术中出血量[（429±184）mL]、肝门阻断总时间[（20.4±6.1）min]及术后住院时间[（11.5±3.6）d]与对照组[（154±86）min、（418±205）mL、（21.7±7.3）min、（10.0±3.5）d]比较,差异无统计学意义（P〉0.05）;但术后第3、7天观察组的ALT、TBIL等肝功指标水平明显低于对照组（P〈0.01）。观察组术后腹腔积液发生率（7.5%）明显低于对照组（30.0%）,差异有统计学意义（P〈0.05）;观察组术后生活质量评分[（4.10±0.90）分]明显高于对照组[（1.76±0.40）分],差异有统计学意义（P〈0.05）。结论半肝入肝血流阻断法能在一定程度上加快肝功能的恢复,且减少其并发症,尤其适合肝细胞癌合并肝硬化手术患者。

Objective To comparative analyze the efficacy and safety of different hepatic inflow occlusion method in patients with hepatocellular carcinoma and cirrhosis surgery. Methods 80 patients with hepatocellular carcinoma and cirrhosis surgery in the People＇s Hospital of Gaozhou City from January 2010 to September 2013 were selected and divided into the control group（total hepatic hepatic vascular occlusion）（Pringle method） and observation group（semiliver hepatic blocking blood flow occlusion way）, with 40 cases in each group. The operative time, blood loss, postoperative hospital stay, postoperative serum alanine aminotransferase（ALT）, total bilirubin postoperative hormone levels（TBIL） and other indicators of liver function, safety of patients in two groups were compared. Results The operation time [（160±75） min], amount of bleeding during operation [（429±184） mL], hepatic portal occlusion time [（20.4±6.1）min] and postoperative hospitalization time [（11.5±3.6） d] in observation group and control group [（154±86） min,（418±205） mL,（21.7±7.3） min,（10±3.5） d] had no statistically significant difference（P〉0.05）; but the indicators of liver function in postoperative 3 and 7 days of observation group, such as ALT, TBIL were significantly lower than those of the control group（P〈0.01）. The incidence of seroperitoneum in observation group（7.5%） was significantly lower than that of the control group（30%）, the difference was statistically significant（P〈0.05）. The quality of life score of the patients in the observation group [（4.1±0.9） points] was significantly higher than that of the control group [（1.76±0.40）points], the difference was statistically significant（P〈0.05）. Conclusion Hemihepatic hepatic vascular occlusion method can accelerate the recovery of liver function to a certain extent, and fewer complications, especially for patients with hepatocellular carcinoma and cirrhosis surgery.