原发性肝癌精准肝切除与不规则性肝切除的对比研究

Precise hepatectomy and irregularity hepatectomy in treatment of primary liver cancer:a comparative study

目的探讨精准肝切除对早期肝癌根治性切除的应用价值。方法采用对比研究方法,收集2012年7月至2014年6月南方医院174例行肝癌根治性切除术肝癌患者的临床资料,将以精准肝切除术施行的设为精准组(118例),以Pringle法施行的设为传统组(56例)。比较分析患者术前基本资料,术中出血量、输血量,术后肝功能恢复情况、住院天数,术后1、2年无瘤生存率等。结果两组患者的性别、年龄、基础肝病、术前白蛋白、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、饮酒史、肝硬化等一般资料比较,差异无统计学意义(P>0.05)。两组患者术中出血量、输血量、手术花费对比,其差异无统计学意义(P>0.05)。精准组较传统组术后肝功能恢复更快,并发症发生率低,住院天数、引流管留置时间更短,差异具有统计学意义(P<0.05)。术后1、2年无瘤生存率精准组为79.7%(94/118)、60.9%(46/118),传统组为50.0%(28/56)、46.4%(26/56),两组比较差异有统计学意义(χ~2=4.741,8.722,P<0.05)。结论早期肝癌以精准肝切除术行根治性切除,患者术后恢复加快,并发症发生减少,具有更好的疗效,临床上可优先考虑该法。

Objective To evaluate the value of precise hepatectomy in treatment of early-stage primaryliver cancer after radical resection. Methods Between June 2012 and July 2014,174 patients undergoing radicalresection of hepatocellular carcinoma were enrolled in this comparative study at Nan fang Hospital. 118 patientswith liver resection under precise hepatectomy were assigned to precise resection group and 56 patients with liverresection under Pringle maneuver were assigned to occlusion group. The two groups were compared in terms ofpreoprational clinical pathological and laboratory data,volume of intraoperative bleeding and blood transfusion,postoperative hepatic function recovery,hospitalization days,and postoperative tumor-free survival rate of 1,2 years. Results There was no significant difference between the two groups in the sex,age,liver disease,preo-pration albumin,ALT,AST,alcohol intake and liver cirrhosis（P 0.05）. No differences between the two groupswere found about the volume of intraoperative bleeding and blood transfusion as well as surgery cost（P 0.05）.The recovery of hepatic function was accelerated and the incidence of complications,hospitalization days and peri-od of drainage were significantly reduced in the precise resection group compared with the occlusion group（P 0.05）. The 1,2-years postoperative tumor-free survival rate was 79.7%（94/118）,60.9%（46/118）in the precisegroup and 50.0%（28/56）,46.4%（26/56）in the occlusion group,with significant difference between them（χ~2= 4.741,8.722,P 0.05）. Conclusions For early-stage liver cancer patients,the precise hepatectomy duringradical resection results in quick recovery and fewer complications,thus it should be the first choice of clinicaloperation.