前入路联合悬吊法切除右肝大肝癌的疗效分析

Therapeutic effect of anterior approach combined with liver hanging maneuver for right hepatectomy in patients with large hepatocellular carcinoma

目的比较前入路联合悬吊法和常规径路法切除右半肝大肝癌手术的近、远期疗效。方法回顾性分析在我院因右肝大肝癌行右半肝切除的62例患者,其中经前入路联合悬吊法切除29例(简称前入路组),常规径路法切除33例(简称常规组),比较两组围手术期情况及远期生存率及复发率等。结果两组在术前资料、术中出血量、肿瘤破裂、术后肝功能恢复及住院时间等方面差异无统计学意义;前入路组总的手术时间(t=1.815,P=0.037)及断肝时间(t=4.591,P=0.000)较长;但是前入路组肿瘤根治性切除率更高(x^2=7.280,P=0.007)。两组1、3和5年总生存率分别为86.1%,50.1%,32.6%和75.8%,30.3%、18.9%,(x^2=5.24,P=0.022);1、3和5年无瘤生存率分别75.3%,42.1%,31.0%和66.1%,24.4%、10.1%,(x^2=4.38,P=0.037);1、3和5年复发率分别为23.6%,49.5%,64.8%和36.7%、63.7%、82.5%,(x^2=5.61,P=0.018)。结论经前入路联合悬吊法在切除右叶大肝癌方面近期结果与常规法相仿,但远期疗效优于常规径路法。

Objective To evaluate hepatectomy by anterior approach combined with liver hanging maneuver against conventional right hepatectomy in patients with large hepatocellular carcinoma(HCC).Methods Of the 62 cases,29 patients underwent anterior approach hepatectomy and 33 did conventional hepatectomy.Results The overall operative time(Z=1.815,P=0.037)and parenchymal transsection time(t=4.591,P=0.000)were longer in the anterior approach group than in the conventional group.More cases got radical resection in the anterior group(x^2=7.280,P=0.007).Log-rank test showed that 1,3 and 5?year overall survival rate(OS)in the anterior approach group and the conventional group was 86.1%,50.1%,32.6%vs 75.8%,30.3%,18.9%,respectively(x^2=5.24,P=0.022),1,3 and 5-year disease free survival rate(DFS)were 75.3%,42.1%,31.0%vs 66.1%,24.4%,10.1%,respectively(x^2=4.38,P=0.037),and recurrence rate were 23.6%,49.5%,64.8%vs 36.7%,63.7%,82.5%,respectively(x^2=5.61,P=0.018).Conclusion Long term survival of patients with large sized HCC undergoing hepatectomy through the anterior approach combined with liver hanging maneuver is better than that of conventional approach.