解剖性肝叶切除与非解剖性肝叶切除治疗原发性肝癌的疗效对比研究

A Comparative Study of the Efficacy of Anatomical Hepatectomy and Non-anatomical Hepatectomy in the Treatment of Primary Hepatocellular Carcinoma

目的:对比解剖性肝叶切除手术(AH)与非解剖性肝叶切除手术(NAH)治疗原发性肝癌(PHC)的疗效。方法:回顾性分析2015年1月~2018年3月期间我院收治的103例PHC患者的临床资料,根据手术方式的不同将患者分为对照组(n=54)和研究组(n=49),对照组给予NAH治疗,研究组给予AH治疗,比较两组围术期指标、黑色素瘤抗原-1(MAGE-1)m RNA、甲胎蛋白(AFP)m RNA阳性表达、肝功能指标、术后并发症及复发转移情况。结果:两组患者术后7d丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)均升高,但研究组低于对照组(P<0.05)。研究组住院时间短于对照组,术中出血量、术中输血量、术后引流量少于对照组(P<0.05),研究组手术时间长于对照组(P<0.05)。两组术后28d的MAGE-1 m RNA、AFP m RNA阳性表达率均有所降低,且研究组低于对照组(P<0.05)。研究组术后并发症发生率以及复发转移率均低于对照组(P<0.05)。结论:与NAH术式相比,AH治疗PHC患者可有效减轻肝功能损害,下调MAGE-1 m RNA、AFP m RNA阳性表达,降低术后并发症及复发转移发生率。

Objective: To compare the efficacy of anatomical hepatectomy(AH) and non-anatomical hepatectomy(NAH) in the treatment of primary hepatocellular carcinoma(PHC). Methods: The clinical data of 103 patients with PHC who were admitted to our hospital from January 2015 to March 2018 were analyzed retrospectively. The patients were divided into control group(n=54) and study group(n=49) according to different surgical methods. The control group was treated with NAH, and the research group was treated with AH. Perioperative indicators, melanoma antigen-1(MAGE-1) gene, alpha-fetoprotein(AFP) gene positive expression, liver function indicators, postoperative complications and recurrence and metastasis were compared between the two groups. Results: Alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin(TBIL) were increased in both groups at 7 days after operation, but those in the study group were lower than those in the control group(P<0.05). The hospitalization time of the study group was shorter than that of the control group, and the intraoperative blood loss, intraoperative blood transfusion and postoperative drainage volume were less than those of the control group(P<0.05), while the operation time of the study group was longer than that of the control group(P<0.05). The positive expression rate of MAGE-1 m RNA and AFP m RNA in the study group were lower than those in the control group at 28 days after operation(P<0.05). The incidence of postoperative complications and recurrence and metastasis in the study group were lower than those in the control group(P<0.05). Conclusion: Compared with NAH operation, AH can effectively alleviate the damage of liver function, down-regulate the positive expression of MAGE-1 m RNA and AFP m RNA, reduce the incidence of complications and recurrence and metastasis.