精准肝切除治疗肝脏肿瘤的疗效评价  

Evaluation of the effect of precise hepatectomy for liver neoplasms

作　　者：江涛[1] 王轩[1] 陆雷[1] 张冬华[1] 张荣生[1] 李增才[1] 张斌[1] 

机构地区：[1]解放军第八一医院肿瘤外科,江苏南京210002

出　　处：《中国普通外科杂志》2011年第7期665-668,共4页China Journal of General Surgery

摘　　要：目的评价精准肝切除术治疗肝脏肿瘤的近期疗效。方法将近2年内收治的143例肝脏肿瘤患者采用前瞻性、非随机对照临床试验的方法行精准肝切除84例(精准组)和行传统肝切除59例(对照组),比较两组手术后的近期效果。精准组采用肝段或肝叶切除方式,术中以半肝阻断或不阻断入肝血流为主。传统组采用肝门血流全阻断下大块钳夹缝扎法。结果精准组手术切除时间[(134±86)min]显著长于对照组[(71±52)min](P<0.01)。两组术中出血量分别为(274±186)mL和(340±220)mL,组间无统计学差异(P=0.055)。术后精准组当日引流量[(175±86)mL]显著少于对照组[(311±98)mL](P<0.01)。精准组术后3 d内血清ALT,AST,总胆红素,C反应蛋白峰值依次分别为(283.9±218.4)U/L,(215.5±171.3)U/L,(27.7±15.9)μmol/L,(35.4±17.3)mg/L,对照组分别为(754.5±273.0)U/L,(692.1±216.7)U/L,(46.3±20.1)μmol/L和(79.5±31.8)mg/L,两组间上述指标差异有统计学意义(均P<0.01)。精准组和对照组术后并发症发生率分别为10.7%和23.7%,差异有统计学意义(P=0.037),但均无围手术期死亡。结论精准肝切除以最小创伤和最大肝脏保护获得了较佳的康复效果,是一种安全、低创的肝切除方法。Objective To evaluate the short-term clinical outcome of precise hepatectomy for liver neoplasms.Methods A prospective,non-randomized controlled study was conducted on 143 selected patients with liver neoplasms admitted to our Hospital in recent two years.Of the patients,84 cases undergoing precise hepatectomy were designated as observation group and 59 cases undergoing conventional hepatectomy were used as control group.The indexes of the perioperative conditions between the two groups were compared.Hepatic lobectomy or segmentectomy was performed in the patients of precise hepatectomy with hemihepatic vascular occlusion or without vascular occlusion.Conventional hepatectomy was performed using clamp-crushing method under total vascular occlusion.Results The mean operative time of the observation group was significantly prolonged compared with the control group [（134±86） min vs.（71±52） min,（P0.01）].No difference was noted between the two groups（P=0.055） in the mean intraoperative bleeding volume,which was（274±186） mL in the observation group and（340±220） mL in the control group（P0.05）.The mean drainage volume of the first postoperative day was（175±86） mL in obsevation group and（311±98） mL in the control group,and the difference between both groups was highly significant（P0.01）.The peak levels of serum ALT,AST,total bilirubin and C-reactive protein at 3 days after operation between the two groups were all significantly different（P0.01）,which were（283.9±218.4） U/L,（215.5±171.3） U/L,（27.7±15.9） μmol/L and（35.4±17.3） mg/L in the observation group,and were（754.5±273.0） U/L,（692.1±216.7） U/L,（46.3±20.1） μmol/L and（79.5±31.8） mg/L in the control group,respectively.The incidence of postoperative complications was 10.7% and 23.7% in obserxation and control group respectively,and that was significantly different（P=0.037）.No perioperative mortality occurred in the 2 groups.Conclusions Precise hepatectomy is a safe,effective and

关 键 词：肝肿瘤/外科学 精准肝切除 血流阻断/方法 

分 类 号：R735.7[医药卫生—肿瘤]