合并肝硬化的大肝癌解剖性肝切除疗效分析

Evaluation of Anatomical Hepatectomy for Large Hepatocellular Carcinoma Associated with Cirrhosis

目的:探讨合并肝硬化的大肝癌行解剖性肝切除的疗效分析。方法:将239例合并肝硬化的大肝癌根据手术方式不同分为解剖性肝切除组(n=148)和非解剖性肝切除组(n=91),观察两组间围手术期及预后情况。结果:解剖性肝切除组手术时间(221±58)min,较非解剖性肝切除组(187±64)min长(P<0.001);但是其术中出血量(450±216)ml明显少于非解剖性肝切除组(822±525)ml(P<0.001);术后住院时间解剖性肝切除组(15±4)d,较非解剖组(17±4)d短(P<0.001);术后肝功能恢复较非解剖性肝切除组快[术后7dALT、AST、TBIL分别为(102±57)U/L、(80±39)U/L、(42.7±21.4)μmol/L比(193±48)U/L、(117±34)U/L、(65.5±20.2)μmol/L;P<0.001];解剖性肝切除组并发症发生率为17.6%(26/148),明显低于非解剖组23.1%(21/91,P<0.05)。解剖性肝切除组术后3、6、12月生存率分别为88.7%、77.4%、66.0%;非解剖性肝切除组分别为86.8%、73.6%、63.1%,两组生存时间比较差异无统计学意义(P>0.05)。结论:对于肝功能储备良好的合并肝硬化的大肝癌可以安全的实施解剖性肝切除,术后恢复快,疗效较好。

Objective：To evaluate the safety and efficacy of the anatomical hepatectomy for large hepatocellular carcinoma（HCC）associated with cirrhosis.Methods：A total of 239 patients with large hepatocellular carcinoma were divided into anatomical hepatectomy group（n=148）and non-anatomical hepatectomy group（control group,n=91）according to different resection methods.Perioperative parameters and prognosis were investigated between the two groups.Results：The duration of anatomical hepatectomy group was longer than that of control group as（221±58）min vs（187±64）min,P〈0.001.However,there were significant differences in blood loss during surgery（[450±216]ml vs[822±525]ml,P〈0.001）,length of hospital stay after hepatectomy（[15±4]d vs[17±4]d;P〈0.001）,postoperative serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）and total bilirubin（TBIL）（[102±57]U/L vs[193±48]U/L,[80±39]U/Lvs[117±34]U/L,[42.7±21.4]μmol/Lvs[65.5±20.2]μmol/L,respectively;P〈0.001]between the two groups.There was a significant difference in incidence of postoperative complications between the two groups（anatomical：17.6%,control：23.1%;P〉0.001）.The 3,6,12-month survival rates were 88.7%,77.4%and 66.0%in anatomical hepatectomy group,respectively,while,86.8%,73.6%and 63.1%in control group,with no significant difference（P〈0.05）.Conclusion：The results suggest that anatomical hepatectomy is safe and effective as a treatment for large HCC patients associated with cirrhosis when the patients preserved liver function are well.