Pringle法和选择性半肝阻断法对肝细胞癌患者术后预后的影响

Effects of Pringle and selective hemihepatic vascular exclusion on postoperative prognosis in patients with hepatocellular carcinoma

目的 探讨Pringle法和选择性半肝阻断法对肝细胞癌患者远期生存率的影响。方法 回顾性分析184例行根治性手术治疗的肝细胞癌患者临床资料,根据肝门阻断方式分为Pringle组(n=122)和选择性半肝阻断组(n=62)。分析两组患者术后1、2、3年的累计生存率和复发率,以及影响患者预后的因素。结果 两组术后累计生存率以及复发率比较,差异均无统计学意义(均P>0.05)。AST≥70U/L、甲胎蛋白≥400ng/mL及输血治疗是导致肝细胞癌患者术后死亡的独立危险因素(均P<0.05)。血小板计数<100×109/L、肿瘤大小≥5cm、肿瘤个数为2~3个以及输血量≥1000mL是导致肝细胞癌患者术后复发的独立危险因素(均P<0.05)。对于肿瘤最大径≥5cm、甲胎蛋白≥400ng/mL、巴塞罗那分期为A期以及HBsAg(+)患者,两种肝门阻断方式的累计生存率比较,差异均无统计学意义(均P>0.05)。结论 Pringle法和选择性半肝阻断法对肝细胞癌术后远期生存率和复发率的影响差异不大,但是选择性半肝阻断法引起肝功能损伤程度弱于Pringle法,对局限于半肝的肿瘤及HBsAg(+)患者,应优先考虑采用选择性半肝阻断法。

Objective To investigate the effects of Pringle and selective hemihepatic vascular exclusion on long-term survival rate in patients with hepatocellular carcinoma.Methods The clinical data of 184 patients with hepatocellular carcinoma who underwent radical surgery were retrospectively analyzed,they were divided into Pringle group(n=122)and selective hemihepatic vascular exclusion group(n=62)according to their hepatic portal occlusion approaches.The cumulative survival rates and recurrence rates at year 1,2,and 3 postoperatively were analyzed in the two groups,and the factors affecting patients′prognosis were analyzed as well.Results There was no statistically significant difference in postoperative cumulative survival rate or recurrence rate between the two groups(all P>0.05).AST≥70 U/L,α-fetoprotein≥400 ng/mL,and blood transfusion therapy were independent risk factors resulting in postoperative death in patients with hepatocellular carcinoma(all P<0.05).Platelet count<100×10 9/L,tumor size≥5 cm,number of tumors amounting to 2-3,and blood transfusion volume≥1 000 mL were independent risk factors for developing postoperative recurrence in patients with hepatocellular carcinoma(all P<0.05).For patients with a maximum tumor diameter≥5 cm,α-fetoprotein≥400 ng/mL,Barcelona Clinic Liver Cancer stage A,or HBsAg-positive,their cumulative survival rates showed no statistically significant difference between the two hemihepatic vascular exclusion approaches(all P>0.05).Conclusion Pringle versus selective hemihepatic vascular exclusion has similar effects on long-term survival rate and recurrence rate after operation in patients with hepatocellular carcinoma,but selective hemihepatic vascular exclusion results in milder liver function impairment than Pringle procedure.For patients with hemihepatic tumors or HBsAg-positive cases,selective hemihepatic vascular exclusion should be preferred.