不阻断肝门的大肝癌切除术

Resection of large hepatocellular carcinoma without employment of Pringle maneuver

目的 研究不阻断肝门的肝切除术在大肝癌切除手术中的价值。方法 回顾性分析30例不阻断肝门的大肝癌切除术 ,并与同期 98例采用肝门阻断的大肝癌切除术做对比。采用单因素和多因素分析的方法 ,研究与大肝癌术后并发症有关的因素。结果 不阻断肝门组术后并发症率低于阻断肝门组 (10 0 %vs 32 7% ,P =0 0 2 )。单因素分析显示年龄、肝门阻断、术中出血量、输血量以及手术时间等与并发症发生有关 ,进一步通过多元逐步回归模型分析发现 ,年龄、肝门阻断、输血量以及手术时间是决定术后并发症发生的 4个独立的预测指标。结论 大肝癌切除手术中有选择性地采用不阻断肝门的肝切除技术是安全可行的。

Objective To investigate the value of hepatic resection without Pringle maneuver in excision of large hepatocellular carcinoma (HCC). Methods The clinical data of 30 patients with large HCC treated with hepatic resection without Pringle maneuver in our hospital were retrospectively analyzed and compared with those of 98 patients treated by hepatic resection with Pringle maneuver at the same period of time. Single-variant and multivariate analyses were applied to study the variants associated with postoperative morbidity. Results The postoperative morbidity was 10.0% and 32.7%, respectively, for the non-Pringle group and Pringle group (P=0.02). Single-variant analysis showed that the age, Pringle maneuver, intraoperative blood loss, blood transfusion and operation duration were associated with postoperative complications. Furthermore, multiple stepwise regression analysis revealed that the age, Pringle maneuver, blood transfusion and operative duration were the independent prognostic parameters of postoperative morbidity. Conclusion It is safe and feasible to selectively adopt hepatic resection without Pringle maneuver for excision of large HCC.