原发性肝癌规则与非规则性肝切除术式探讨  

Clinical study of regular hepatectomy and irregular hepatectomy in primary liver cancer

作　　者：冯志强[1] 肖梅[1] 张洪义[1] 黄志强[2] 徐立宁[3] 张辉[1] 张宏义[1] 甄玉英[1] 

机构地区：[1]中国人民解放军空军总医院肝胆外科,北京100142 [2]中国人民解放军总医院肝胆外科,北京100853 [3]中国人民解放军总医院南楼临床部外二科,北京100853

出　　处：《中国实用外科杂志》2012年第3期226-228,共3页Chinese Journal of Practical Surgery

基　　金：国家传染病防治科技重大专项(2008ZX1002-26)

摘　　要：目的分析原发性肝癌规则性肝切除和非规则性肝切除的围手术期因素,探讨原发性肝癌治疗中二者手术适应证。方法回顾性分析中国人民解放军空军总医院1990-2010年原发性肝癌中274例规则性肝切除术和586例非规则性肝切除术病人的临床资料。结果统计分析表明,规则性肝切除与非规则性肝切除相比,对术前病人肝功能状态要求更加严格,术中切除肝体积以及出血量、输血量均较非规则性肝切除组显著增多,手术时间延长,术后并发症发生率增加。但实施规则性肝切除术病人的肿瘤体积明显大于非规则性肝切除病人,切除肝段数目大于三段者所占比例亦显著高于非规则性肝切除组。结论对于<5cm的肝癌病人,采用非规则性肝切除保留更多功能性肝实质,可能更有利于病人术后恢复,减少相关并发症的发生。Objective To investigate surgical indication for primary liver cancer according to analyze operative and perioperative factors of regular hepatectomy and irregular hepatectomy. Methods The operative and perioperative factors of 274 cases of regular hepatectomies and 586 cases of irregular hepatectomies in primary liver cancer performed from 1990 to 2010 at Chinese PLA Air Force General Hospital were investigated retrospectively according to their medical documentation. Results Statistical analysis showed that the regular hepatectomy need a more stringent requirements in the liver function and more liver volume, blood loss, transfusion, moe operation time than the irregular hepateetomy. It also increased the rate of postoperative complications. But the tumor volume of regular hepateetomies was significantly greater than the irregular hepateetomies, and the proportion of three sections hepatectomy or more sections is significantly higher than the irregular hepatectomies. Conclusion For tumors less than 5cm of liver cancer, irregular hepatectomy can retain more functional liver parenchyma. Maybe it is more conducive to the recovery of patients after the operation and reduce the associated complications.

关 键 词：原发性肝癌 肝切除术 规则性切除 非规则性切除 围手术期 

分 类 号：R6[医药卫生—外科学]