精准肝切除理念下的中央型肝癌外科治疗

Evaluation of precise hepatectomy for centrally located hepatocellular carcinoma

目的:探索精准肝切除理念下的中央型肝癌治疗的价值。方法:回顾性分析2009年1月至2013年10月于我院就诊并手术的中央型肝癌患者临床资料。共有72例中央型肝癌患者纳入本研究,其中精确肝切除组47例(精准组),传统肝切除组25例(传统组)。结果:精准组与传统组平均术中失血量分别为(320±145) ml和(313±246) ml,两组比较差异无统计学意义(P> 0. 05);术中输血率分别为10. 6%(5/47)和28. 0%(7/25),两组比较差异有统计学意义(P <0. 05);术后并发症发生率分别为21. 3%(10/47)和24. 0%(6/25),两组比较差异无统计学意义(P> 0. 05);平均住院时间分别为(12. 3±2. 6) d和(12. 6±2. 4) d,两组比较无统计学差异(P> 0. 05)。精准组和传统组中位无瘤生存时间及总生存时间分别为43个月、45个月和28个月、37个月,两组比较无统计学差异(P> 0. 0 5)。肿瘤有无包膜(P=0. 002)、脉管有无瘤栓(P=0. 000)、切缘状态(P=0. 009)是影响中央型肝癌术后生存率的危险因素。在切缘阴性前提下,切缘宽度(> 2 cm,1～2 cm,0～1 cm)对术后生存率无统计学意义(P=0. 886)。结论:精准肝蒂解剖法可以达到和传统的肝切除术相同的治疗效果和安全性;在保证切缘阴性的情况下,最小切缘的距离不是影响生存的主要因素。

Objective：To evaluate the value of precise hepatectomy for centrally located hepatocellular carcinoma.Methods：A retrospective study was conducted on patients who were diagnosed with centrally located hepatocellular carcinoma and received surgery treatment from January 2009 to October 2013.A total of 72 patients with centrally located hepatocellular carcinoma were divided into precise hepatectomy group （n=47） and conventional hepatectomy group （n=25）.Results：Mean blood loss was （320±145） ml in precise hepatectomy group and （313±246） ml in conventional hepatectomy group with no significant difference （P〉0.05）.Intraoperative blood transfusion rate increased significantly in conventional hepatectomy group [10.6%（5/47） vs 28.0%（7/25）,P〈0.05].There was no significant difference in postoperative complication [（21.3%（10/47） vs 24.0%（6/25）] and mean hospital stay [（12.3±2.6） d vs （12.6±2.4） d] between precise and conventional hepatectomy group （P〉0.05）.The median sease-free survival time and overall survival time were 43 and 45 months vs 28 and 37 months between two groups,with no significant differences （P〉0.05）.Tumor capsular （P=0.002）,microvascular invasion （P=0.000） and surgical margin status （P=0.009） were prognostic factors for postoperative survival rates.Surgical margin width （〉2 cm,1~2 cm and 0~1 cm） showed no significant difference in postoperative survival rates （P=0.886） when a negative surgical margin was obtained.Conclusion：Precise hepatic pedicle dissection has the same safety and efficacy as conventional method in hepatectomy.Surgical margin width is not a main factor affecting postoperative survival rates when a negative surgical margin is obtained.