精准肝切除与传统肝切除术治疗原发性肝癌的疗效对比

A comparative analysis of curative effect between precise hepatectomy and traditional hepatectomy for primary hepatocellular carcinoma

目的总结精准肝切除治疗原发性肝癌的经验体会。方法回顾性分析2013年1月至2017年12月临沧市人民医院施行肝切除术的202例原发性肝癌患者的临床资料。其中采用精准肝切除术101例(精准组),Pringle法肝切除101例(传统组),对比分析两组患者的术前资料,术中出血量、手术时间,术后胆汁漏、肿瘤标本切缘阳性率、术后肝功能指标、术后住院时间、术后6个月AFP值,以及术后1、3年无瘤生存率等指标。结果精准组与传统组的术中出血量[(505.5±64.1)mLvs(709.9±61.2)mL]、手术时间[(331.4±42.3)minvs(318.1±52.5)min]、术后胆汁漏(1%vs4%)、肿瘤标本切缘阳性率(8.7%vs19.1%)、术后住院时间[(16.1±3.4)dvs(24.5±4.1)d]、术后6个月AFP<10μg/L率(91.3%vs78.8%)以及术后1、3年无瘤生存率(分别为71.7%vs53.2%、48.9%vs30.9%)差异均有统计学意义(P<0.05)。结论相比传统肝切除术,精准肝切除术具有术中出血少、术后并发症发生率低、住院时间缩短、无瘤生存率高等优势。

Objective To summarize the experience of precise hepatectomy in the treatment of primary hepatocellular carcinoma. Methods Clinical data of 202 patients with primary hepatocellular carcinoma who underwent hepatectomy in Lincang People’s Hospital from Jan. 2013 to Dec. 2017 were retrospectively analyzed. Precision hepatectomy was performed in 101 cases (precise group) and Pringle hepatectomy was performed in 101 cases (traditional group). The preoperative data, intraoperative bleeding volume, operation time, bile leakage, positive rate of incision margin, liver function index, hospitalization time, AFP level 6 months after operation, tumor-free survival rate of 1 and 3 years after operation were compared between the two groups. Results Between precision group and traditional group, there were significant differences in intraoperative bleeding volume [(505.5±64.1) mL vs (709.9±61.2) mL], operative time [(331.4±42.3) min vs (318.1±52.5) min], bile leakage after operation (1% vs 4%), positive rate of incision margin (8.7% vs 19.1%), hospitalization time [(16.1±3.4) d vs (24.5±4.1) d], rate of AFP<10 μg/L 6 months after operation (91.3% vs 78.8%), tumor-free survival rates 1 and 3 years after operation (71.7% vs 53.2%, 48.9% vs 30.9%), all P<0.05. Conclusion Compared with traditional hepatectomy, precise hepatectomy has the advantages of less bleeding during operation, lower complications after operation, shorter hospitalization time and higher tumor-free survival rate.