Glisson蒂阻断术式对原发性肝癌患者的疗效及预后的影响

Effect of Glisson's pedicle occlusion on the curative effect and prognosis of patients with primary liver cancer

目的探讨Glisson蒂阻断术式对原发性肝癌患者的疗效及预后的影响,为治疗原发性肝癌提供临床指导。方法回顾性分析2014年1月至2015年1月在三峡大学第二人民医院普外二科住院治疗的60例患者的临床资料,依据手术方法不同分为观察组和对照组,每组30例。对照组采用Pringle法阻断第一肝门手术治疗,观察组采用Glisson蒂阻断手术治疗。比较两组患者的手术时间、手术出血量、术中输血量、肝血流阻断、肝功能相关指标、术后并发症以及术后生存率。结果观察组患者肝血流阻断时间为(31.5±8.9) min,与对照组的(29.8±8.2) min比较差异无统计学意义(P>0.05);观察组患者的手术时间和住院时间分别为(82.6±3.4) min、(11.3±2.1) d,明显短于对照组的(105.1±2.4) min和(15.2±2.5) d,差异均有统计学意义(P<0.05);观察组患者手术出血量和术中输血量分别为(133.5±24.4) mL、(197.3±12.3) mL,明显低于对照组的(184.3±30.1) mL和(258.1±14.6) mL,差异均有统计学意义(P<0.05);术后,两组患者的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、凝血酶原时间(PT)均明显升高,且观察组ALT、AST、TBIL、PT明显高于对照组,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率为6.7%,明显低于对照组的13.3%,术后3年生存率的70.0%,明显高于对照组的50.0%,差异均有统计学意义(P<0.05)。结论 Glisson蒂阻断术治疗原发性肝癌患者具有出血少、手术时间短、恢复快、并发症少的优点,同时可以有效改善肝功能,提高生存率,值得临床上推广。

Objective To explore the effect of Glisson’s pedicle occlusion on the curative effect and prognosis of patients with primary liver cancer, and to provide clinical guidance for the treatment of primary liver cancer.Methods The clinical data of 60 patients were retrospectively analyzed, who were hospitalized in the Second Department of General Surgery at the Second People’s Hospital of Three Gorges University from January 2014 to January2015. According to different surgical methods, the patients were divided into observation group and control group, with30 cases in each group. The control group was treated with Pringle method for blocking the first hepatic portal operation,and the observation group was treated with Glisson pedicle blocking operation. The operation time, bleeding volume, intraoperative blood transfusion volume, hepatic blood flow occlusion, liver function related indicators, postoperative complications, and postoperative survival rate were compared between the two groups. Results The time of hepatic blood flow occlusion in the observation group was(31.5±8.9) min, which was not statistically significant compared with(29.8±8.2) min in the control group(P>0.05). The operation time and hospitalization time in the observation group were(82.6±3.4) min and(11.3±2.1) d, respectively, which were significantly shorter than corresponding(105.1±2.4) min and(15.2±2.5) d in the control group(P<0.05). The bleeding volume and intraoperative blood transfusion volume in the observation group were respectively(133.5 ± 24.4) mL,(197.3 ± 12.3) mL, which were significantly lower than corresponding(184.3±30.1) mL and(258.1±14.6) m L in the control group(P<0.05). After operation, alanine aminotransferase(ALT),aspartate aminotransferase(AST), total bilirubin(TBIL), and prothrombin time(PT) were significantly elevated in the two groups;and the ALT, AST, TBIL and PT in the observation group were significantly higher than those in the control group(P<0.05). The incidence of postoperative complications in the observation group was 6.7%, which was significantly lower than 13.3% in the control group;and the postoperative 3-year survival rate was 70.0%, which was significantly higher than 50.0% in the control group(P<0.05). Conclusion Glisson’s pedicle occlusion has the advantages of less bleeding, shorter operation time, quicker recovery and fewer complications in the treatment of primary liver cancer, and can effectively improve liver function and improve survival rate. It is worthy of clinical promotion.