解剖性肝切除术对晚期肝癌患者肝功能及预后的分析

目的探讨解剖性肝切除术对晚期肝癌患者肝功能及预后的影响。方法收集2012年3月至2013年2月86例中晚期原发性肝癌患者肝根治性切除术患者的临床资料，根据手术方式分为观察组和对照组各54例，观察组实施解剖性肝切除术，对照组实施非解剖性肝切除术，比较两组手术相关指标、肝功能变化、并发症及随访情况。结果观察组手术时间明显长于对照组，术中出血量、输血量明显低于对照组，住院时间明显短于对照组（t=5．668，7．927，15．145，3．432，P〈0．05）；术后1周，观察组血清ALT、AST、TBIL、DBIL含量均明显低于对照组（t=11．567．10．062，6．126，11．390，P〈0．05）；观察组发生胸腔积液等并发症27．91％明显低于对照组48．84％（x2=3．983，P〈0．05）；随访10-36个月，观察组复发率、转移率均明显高于对照组（18．60％vs39．53％，16．28％w34．88％）（x2=4．568，3．909，P〈0．05），两组病死率比较差异无统计学意义（13．95％VS23．26％）（x2=1．228，P〉0．05）。结论解剖性肝切除术有助于减少术中出血，减轻围术期肝功能损害，降低术后并发症及复发率，提高患者预后。

Objective To investigate the effect of anatomical liver resection for patients with liver function and prognosis of advanced hepatocellular carcinoma. Methods The clinical data of 86 patients with primary liver carcinoma after radical resection were collected from March 2012 to February 2013, the patients were divided into the observation group and the control group with 54 cases in each group, the observation group implemented anatomical liver resection, control group received non anatomical liver resection, related indexes were compared between the two groups including the changes of liver function, complications and follow-up. Results The operation time of the observation group was significantly longer than the control group, the amount of bleeding, blood transfusion volume were significantly lower than the control group, the hospitalization time was significantly shorter than the control group （t=5.668, 7.927, 15.145, 3.432, P〈0.05, P〈0.001 ） ; after 1 weeks, the serum levels ofALT, AST, TBIL, DBIL were significantly lower than that of the control group （t=l 1.567, 10.062, 6.126, 11.390, P〈0.05, P〈0.001 ） ; pleural effusion and other complications occurred in the observation group 27.91% was significantly lower than the control group （ X 2=3.983, 48.84% P〈0.05 ） ; observation group was followed up for 10-36 months. The recurrence rate and metastasis rate were significantly higher than the control group （ 18.60% vs 39.53%, 16.28% vs 34.88%） （ X 2=4.568, 3.909, P〈0.05 ） , the two groups had no statistically significant differences in mortality （ 13.95% vs 23.26% ） （ X 2=1.228, P〉0.05 ） . Conclusion Anatomical liver resection helps to reduce intraoperative bleeding, reduce the damage around preoperative liver function, reduce the postoperative complications and recurrence rate, improve the prognosis of patients.