Tissue－Link联合肝癌切除的疗效Cusa与Pringle指捏法分析

Tissue-Link and Cusa vs Pringle＇s maneuver in hepatectomy for hepatocellular carcinoma

目的探讨Tissue－Link和Cusa联合应用在肝癌切除手术术中应用及术后的效果。方法选取术中采用Pringle指捏法（A组）或Tissue-Link联合Cusa（B组）进行肝癌切除的患者，比较2组患者术中及术后恢复情况。结果B组手术时间比A组长（t=-2．896，P=0．006）；B组术中出血量较A组少（t=2．030，P=0．023）；术后第1、7天2组患者转氨酶变化无差别，其中第7天2组总胆红素比较差异有统计学意义（t=1．687，P=0．034）：B组术后白蛋白补充量少于A组（t=1．551，P=0．042）；2组患者术后并发症总发生率差异无统计学意义（χ^2=2．14，P=0．499），均未发生死亡；2组平均住院时间无差别（t=3．71，P=0．305）；A组切缘肿瘤复发率、肝内转移、肝外转移率均高于B组（分别P=0．029，0．021，0．016）。第2年和第3年B组的无瘤生存率高于A组（分别P=0．047，0．036）；B组患者第3年的总生存率高于A组（χ^2=4.01，P=0．042）。结论与Pringle指捏法相比，Tissue—Link联合Cusa应用于原发性肝癌切除术，术中出血少。减少了术后并发症的发生率，有利于术后肝功能的恢复，降低术后肿瘤复发／转移率、提高无瘤生存率和总生存率。

Objective To evaluate the short-term and long-term clinical effect of hepatectomy using Tissue-Link ＆ Cusa, compared to the Pringle maneuver. Methods Clinical data of 87 HCC patients who had received hepatectomy by the Pringle＇s Maneuver （group A） or Tissue-Link ＆ Cusa （group B） were retrospectively analyzed. Results The average amount of bleeding in Group A was more than group B （ t = 2. 030,P = 0. 023 ）. The time of operation in group A was shorter than group B （ t = - 2. 896, P = 0. 006 ）. The postoperative supplement of albumin in group A was more than group B, the level of serum total bilirubin on 7th day after operation was higher than group B （ P 〈 0. 05 ） . There was no significant difference in postoperation complications and the time in hospital （ P 〉 0. 05 ）. The rate of ineisional recurrence and the rate of metastasis in or out of the liver in group A were higher than group B （P =0. 029, 0. 021, 0. 016）. The 2- and 3-year tumor-free survival rates and the 3-year overall survival rates in group A were lower than that in group B （P = 0. 047, 0. 036, 0. 042）. Conclusions Hepatectomy using Tissue-Link ＆ Cusa is superior to the Pringle＇s maneuver for the treatment of primary hepatocellular carcinoma. It has a clear operative field,less operative bleeding,less damage to liver function and a lower relapse rate of incisional margin.