原发性肝癌合并膈肌侵犯的手术治疗

Surgical treatment of primary liver cancer with diaphragmatic muscle invasion

目的 探讨原发性肝癌合并膈肌侵犯的手术治疗可行性及远期疗效.方法 回顾性分析2008年1月至2014年1月间安徽省立医院37例肝癌侵犯膈肌患者的临床资料,选择同期行肝癌根治术患者54例作为对照组.结果 所有病例手术均成功,术前2组患者临床资料差异无统计学意义,合并膈肌侵犯组手术时间较未侵犯组稍长[（149.4 ±23.4） min比（137.9 ±24.6） min,t=2.228,P=0.028],2组术中出血量差异无统计学意义[（449.5±304.1） ml比（412.0±222.3）ml,t=0.678,P=0.499].术后2组患者肺部感染、胸腔积液、切口感染、死亡率及住院时间各方面差异无统计学意义.两组的无瘤生存率和总生存率差异均无统计学意义（P1=0.982,P2=0.906）.结论 肝癌合并膈肌侵犯依然是肝切除的适应证,连同部分膈肌一同切除是安全、有效的,并非肝癌预后不良的指标.

Objective To explore the way and the effect of surgical treatment of primary hepatic carcinoma with diaphragmatic invasion.Method Clinical data of 37 primary hepatic carcinoma patients with diaphragmatic muscle invasion undergoing enbloc liver resection in Anhui Provincial Hospital between January 2008 and January 2014 were retrospectively analyzed.Control group comprised 54 liver cancer patients without diaphragm involvement.Results All cases underwent surgery successfully,no significant statistical differences were found between pre-operation clinical data of two groups.The operation time of the group with diaphragmatic invasion is slightly longer than that of the group without （149.4 ± 23.4 min vs 137.9 ±24.6 min,t =2.228,P =0.028）;meanwhile,there was no obvious difference between blood loss of the two groups （449.5 ±304.1 ml vs 304.1 ±222.3 ml,t =0.678,P =0.499）.There were no significantly statistical differences in other aspects between the two groups such as postoperative pulmonary infection,pleural effusion,infection of the incision,mortality and hospitalization time.Based on Kaplan Meier-log-rank test analysis,it is found that the two groups had no significant differences in disease-free survival and overall survival （P1 =0.982,P2 =0.906）.Conclusions Hepatic carcinoma patients with diaphragmatic invasion are still indicated for liver resection with a favorable prognosis.