精准肝切除治疗原发性肝癌的临床研究

Clinical study of precise hepatectomy for the treatment of primary liver cancer

目的研究精准肝切除(PLR)治疗原发性肝癌(PHC)的临床疗效。方法选择2008年1月至2016年1月行手术治疗PHC患者98例,依据随机数字表法分为PLR组与非规则性肝切除(ILR)组各49例。PLR组行精准肝切除,ILR组行非规则性肝切除。观察两组术中出血量、肝门阻断时间、手术时间、输血量、肛门排气时间、腹腔引流量及住院时间等手术相关指标,术后7 d白蛋白(ALB)、总胆红素(TB)、丙氨酸氨基转氨酶(ALT)等肝功能指标峰值,切缘癌残留,术后7 d血清Polo样激酶1(Plk1)、胸腺激酶(TK1)、凋亡抑制因子(Livin)、X连锁凋亡抑制蛋白(Xiap)等肝癌活力指标,术后并发症等。结果 PLR组肝门阻断时间、手术时间长于ILR组,术中出血量、输血量、肛门排气时间、腹腔引流量及住院时间均低于ILR组,差异有统计学意义(P<0.05)。术后7 d,PLR组术后TB、ALT峰值低于ILR组,血清Plk1、TK1、Livin、Xiap水平均低于ILR组,差异有统计学意义(P<0.05)。PLR组切缘癌残留率(8.16%)低于ILR组(28.57%),术后并发症发生率(6.12%)低于ILR组(24.49%),差异有统计学意义(P<0.05)。结论与ILR比较,PLR治疗PHC可完整切除病灶,避免过度挤压病灶导致恶性物质进入血液,并发症发生率低,术后恢复快,值得应用于临床。

Objective To study clinical efficacy of the precise hepatectomy（ Precise liver resection,PLR） therapy for primary hepatocellular carcinoma（ Primary liver cancer,PHC）. Methods From January 2008 to January 2016,98 cases of PHC for surgical treatment,based on the random number table were divided into PLR（ precision liver resection group） and ILR（ irregular liver resection group）,with 49 cases in each group. Bleeding volume,liver door blocking time,surgery time,transfusion volume,anal exhaust time,abdominal introduction flow and the hospital time,surgery related index,postoperative 7 d albumin（ ALB）,and total bilirubin（ TB）,and Alanine aminotransferase（ ALT）,liver function index peak,cut margin cancer residues,postoperative 7d serum Polo sample kinase 1（ Plk1）,and thymus kinase 1（ TK1）,and Inhibitor of apoptosis（ Livin）,and X chromosome linked inhibitor of apoptosis protein（ Xiap）,liver cancer vitality index Postoperative complications were observed. Results Portal triad clamping time in PLR group was longer than that of the ILR,intraoperative blood loss,blood transfusion,flatus,abdominal cavity volume and length of stay were below than those of ILR group with statistically significant differences（ P〈0. 05）. Postoperative 7d,postoperative TB in PLR group,peak ALT were lower than those of ILR group,Plk1,TK1,Livin,Xiap levels were lower than those of the ILR group,there were statistically significant differences（ P〈0. 05）. The residual tumor（ 8. 16%） rate in PLR group was below that of the ILR（ 28. 57%）,the incidence of postoperative complications（ 6. 12%） below the that of ILR（ 24. 49%） with statistically significant differences（ P〈0. 05）. Conclusion Compared with ILR,the application of PLR in PHC,can avoid excessive compression which may make unhealthy substances into the blood stream,incidence of complications is low,recovery after surgery is quicker. Therefore,it is worthy of clinical promotion.