前入路绕肝提拉法联合Glisson蒂横断式右半肝切除术治疗肝右叶巨大肝癌的临床效果

Effect of Liver Hanging Maneuver Combined with Glisson Pedicle Right Hemihepatectomyon Giant Hepatocellular Carcinoma in Right Lobe of Liver

目的探讨前入路绕肝提拉法(LHM)联合Glisson蒂横断式右半肝切除术(RH)治疗肝右叶巨大肝癌的临床效果。方法回顾性收集106例肝右叶巨大肝癌患者的临床资料,按治疗方案不同分为2组:对照组53例接受常规RH治疗,研究组53例接受前入路LHM联合Glisson蒂横断式RH治疗。比较2组围手术期指标(术中失血量、输血率及肿瘤破裂率)、手术前后血清肿瘤细胞生长因子[基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)、基质细胞衍生因子1α(SDF-1α)]水平及并发症发生率。结果与对照组比较,研究组术中失血量、输血率、肿瘤破裂率均显著降低(均P<0.05);与术前比较,2组术后血清MMP-9、VEGF、SDF-1α水平均显著降低,且研究组术后上述指标降低更为明显(均P<0.05);与对照组比较,研究组并发症总发生率显著降低(P<0.05)。结论前入路LHM联合Glisson蒂横断式RH治疗肝右叶巨大肝癌可有效优化围手术期指标,抑制肿瘤细胞生长,安全性高。

Objective To investigate the effect of liver hanging maneuver(LHM)combined with Glisson pedicle right hemihepatectomy(RH)ongiant hepatocellular carcinoma in the right lobe of the liver.Methods Clinical data of 106 patients with giant hepatocellular carcinoma in the right lobe of the liver were collected retrospectively.These patients were divided into two groups,with 53 patients in each group.The control group received routineRH,while the study group was treated with combined LHM and Glisson pedicle RH.Perioperative indicators(intraoperative blood loss,blood transfusion rate and tumor rupture rate),serum levels of matrix metalloproteinase-9(MMP-9),vascular endothelial growth factor(VEGF)and stromal cell-derived factor-1α(SDF-1α),and incidence of complications were compared between the two groups.Results Compared with the control group,intraoperative blood loss,blood transfusion rate,tumor rupture rate and incidence of complications were significantly reduced in the study group(all P<0.05).After operation,serumMMP-9,VEGF and SDF-1αlevels dramatically decreased in both groups,and the decrease in the study group was more obvious than that in the control group(all P<0.05).Conclusion The combination of LHM and Glisson pedicle RH can effectively and safely optimize perioperative indicators and inhibit tumor cell growth in patients with giant hepatocellular carcinoma in the right lobe of the liver.