两种经Glisson蒂鞘解剖路径肝切除术治疗原发性肝癌的肿瘤学疗效及风险比对

Comparison of oncologic efficacy and risk of two kinds of hepatectomy via Glisson pedicle sheath anatomical route for primary liver cancer

目的:比较两种经Glisson蒂鞘解剖路径肝切除术治疗原发性肝癌(PHC)的肿瘤学疗效及风险。方法:回顾性收集2018年2月至2021年5月行肝切除术的115例PHC患者病例资料,根据术式不同分为鞘内组(n=60例,行Glisson蒂鞘内阻断法肝切除术)和鞘外组(n=55例,行Glisson蒂鞘外阻断法肝切除术)。采用SPSS 23.0统计软件分析数据,手术相关指标等以(x±s)表示,采用独立样本t检验;总缓解率采用秩和检验,并发症采用χ^(2)检验。采用Kaplan-Meier进行生存分析,行Log-Rank检验。P<0.05为差异有统计学意义。结果:鞘外组患者手术时间、缺血线出现时间、术中出血量均低于鞘内组(P<0.05);两组患者住院时间、总缓解率、并发症总发生率、术后2年复发率及术后2年总生存率相比,差异无统计学意义(P>0.05)。结论:两种经Glisson蒂鞘解剖路径肝切除术治疗PHC具有相似的肿瘤学疗效和短期预后,但与经Glisson蒂鞘内阻断法相比,经Glisson蒂鞘外阻断法可有效减少手术时间及术中出血。

Objective:To compare the oncologic efficacy and risk of hepatectomy via Glisson pedicle sheath anatomical route in the treatment of primary liver cancer(PHC).Methods:The medical data of 115 PHC patients who underwent hepatectomy from February 2018 to May 2021 were retrospectively collected,and were divided into intrathecal group(n=60 patients undergoing intrathecal resection with Glisson pedicle occlusion)and extrathecal group(n=55 patients undergoing intrathecal resection with Glisson pedicle occlusion)according to different operation methods.SPSS 23.0 statistical software was used to analyze the data.Surgical indicators were expressed as(x±s)and independent sample t test was used.The overall response rate was tested by Rank Sum test and the complications were tested byχ^(2) test.Survival analysis was performed by Kaplan-Meier and Log-Rank test was performed.P<0.05 was considered statistically significant.Results:Operative time,ischemic line occurrence time and intraoperative blood loss in extrinsic group were lower than those in intrathecal group(P<0.05).There was no significant difference in length of hospital stay,total remission rate,total complication rate,2-year postoperative recurrence rate and 2-year postoperative survival rate between 2 groups(P>0.05).Conclusion:The two types of intrathecal resection via Glisson pedicle anatomical route have similar oncologic efficacy and short-term prognosis for PHC.However,compared with intrathecal resection via Glisson pedicle,intrathecal resection via Glisson pedicle can effectively reduce operative time and intraoperative bleeding.