术中B超在肝癌切除术中的应用  

Intraoperative Ultrasonography in Liver Resections for Hepatocellular Carcinoma

作　　者：侯宝华[1] 简志祥[1] 孙建[1] 陈伟[1] 区金锐[1] 

机构地区：[1]广东省人民医院肝胆外科,广东广州510080

出　　处：《中国临床医学》2006年第3期410-412,共3页Chinese Journal of Clinical Medicine

基　　金：广东省科技计划资金(2002B30207-3);广东省自然科学基金项目(5300816)

摘　　要：目的：评价术中B超在原发性肝癌手术切除中的应用价值；比较术中B超引导下的肝癌切除术、术中B超引导下肝段门静脉阻断灌注化疗并肝段染色后肝癌切除术与常规肝癌切除术的临床疗效。方法：56例肝癌病人在术中B超引导下进行肝癌切除术；41例肝癌病人应用术中B超引导肝段门静脉阻断灌注化疗并肝段染色后行肝癌切除术；35例行常规肝癌切除术。术后定期复查肝功能、AFP,CT及MRI,并随访。结果：术中B超对直径＜3 cm小肿瘤检出阳性率为93.1%,直径＞3 cm为100%；应用术中B超使19.6%(19/97)的病人改变了原手术方案；术中B超引导下的肝癌切除组和B超引导下肝段门静脉阻断灌注化疗并肝段染色后肝癌切除组较常规肝癌切除组术中出血少,对肝功能影响小,其术后5年生存率分别为31.9%、37.8%和24.3%；局部复发率分别为33.9%、31.7%和57.1%。结论：术中B超对肝癌定位准确,能够提高手术安全性、彻底性和合理性；B超引导下肝段门静脉阻断灌注化疗并肝段染色后肝癌切除组的临床疗效优于术中B超引导下的肝癌切除组,且它们明显优于常规肝癌切除组。Objective：The purpose of this study was to evaluate the current value of intraoperative ultrasonography（IOUS） in liver resection for hepatocellular carcinoma, Methods：Among 132 patients with hepatocellular carcinoma underwent hepatic resections,56 patients underwent the procedure guided by IOUS （group A）, 41 patients underwent hepatic segmentectomy guided by intraopemtive ultrasound and combined with intra-operative segmental staining and chemotherapy following segmental portal vein branch occlusion by a balloon catheter （group B） and 35 patients underwent conventional resections（group C）. AFP,CF and MRI were used regularlyultrasound during the follow-up period to evaluate the outcome, Results：The intraoperative ultrasonography could detect 93. 1% tumors whose diameters were less than 3cm and detect 100% tumors whose diameters were larger than 3cm. 19, 6% paticnets undergoing resection of primary carcinoma of the liver had the planned procedure changed by IOUS. The results of the group A, B and C were as follows： 5-year survival rate were 31.9%, 37, 8% and 24. 3% respectively, local recurrence rates were 33.9%, 31.7% and 57. 1%. Conclusion：Intraoperative hepatic ultrasonography can locate the focus accurately, improve surgical safety and make the operation more radical. It can change the clinical management of patients undergoing resection of primary carcinoma of the liver. The preliminary result showes that the ultrasound-guided liver resection to the treatment of hepatic carcinoma is more effective than traditional hepatectomy.

关 键 词：肝细胞癌 术中超声检查 药物疗法 

分 类 号：R645.2[医药卫生—外科学]