手术治疗原发性肝癌(附87例报告)(英文)

Hepatectomy for hepatocellular carcinoma(report of 87 cases)

目的探讨原发性肝癌(HCC)手术切除的安全性、手术方式和相关技巧。方法回顾性分析近5年在我科施行手术治疗的原发性肝癌病例资料。结果有乙型肝炎病史31例,合并肝硬化41例。肝功能A级45例,B级23例,C级19例。施行左外叶切除19例,左半肝切除25例,右半肝切除17例,肝段切除26例。45例采用Pringle术,肝血流阻断时间为(15±5)min,最长25min;33例采用半肝血流阻断术,阻断时间为(25±8)min,最长47min;12例采用全肝血流阻断术,阻断时间为(12±4)min,最长者为17min。术中出血量为(1245±775)ml,输血量为(800±400)ml,手术时间为(215±85)min。术后并发症发生率为17%,严重并发症发生率为5%,死亡2例,住院时间为(20±8)d。术后1,3,5年存活率分别为73%,50%,37%。结论严格的术前评估、合理的手术方式和熟练的止血、切肝技术是确保手术安全、减少术后并发症、改善临床疗效的关键。

Objective:To investigate security,surgical methods and correlative techniques of hepatectomy in treatment of hepatocellular carcinoma(HCC).Methods:The clinical data of87HCC patients received hep-atectomy in our department in recent5years were retrospectively analyzed.Results:Upon admission,31pa-tients had the history of hepatitis B and41cases were complicated with hepatocirrhosis.Liver function grade A was found in45cases,grade B in23cases and grade C in19cases.Left lateral lobectomy was per-formed in19cases,left-half lobectomy in25cases,right-half lobectomy in17cases and segmentectomy in26cases.Pringle procedure was employed in45cases for(15±5)min(the longest25min),semi-liver blood occlusion in33cases for(25±8)min(the longest47min)and modified Heaney procedure in12cases for(12±4)min(the longest17min).Perioperative blood loss was(1245±775)ml with(800±400)ml of blood infu-sion.The average operative duration was(215±85)min.Postoperative complication occurring rate was17%,and severe complication occurring rate was5%.2patients died.Hospital stay was(20±8)d.After the opera-tion,1-,3-,and5-year survival rates were73%,50%and37%,respectively.Conclusions:Strict preopera-tive evaluation,reasonable operative methods and practiced techniques of hemostasis and hepatectomy are the key points to ensure security,decrease postoperative complications and improve clinical outcome.