半肝血流完全阻断预防肝癌切除术中肿瘤播散的作用  

The role of complete hemihepatic vascular exclusion in the prevention of tumour dissemination during hepatectomy

作　　者：童颖[1] 杨甲梅[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,200438

出　　处：《中华肝胆外科杂志》2012年第7期512-514,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市科学技术委员会资助课题（08411965400）

摘　　要：目的探讨半肝血流完全阻断预防肝癌切除术中肿瘤播散的有效性。方法对照分析2006年2月至2010年4月符合筛选标准的281例肝癌切除病例资料。其中89例采用半肝血流完全阻断法控制术中出血（A组），192例采用Pringle法控制术中出血（B组）。比较两组术后1、2、3年肝内复发率、肺转移发生率和总体无瘤生存率。结果A组患者术后1年肺转移发生率显著低于B组（6．7％比15．1％，P=0．048）。两组患者术后2、3年肺转移发生率（分别为15．7％、32．6％比25．0％、30．7％）及术后1、2、3年肝内复发率无显著差异（分别为20．2％、51．7％、68．5％比31．8％、60．3％、79．2％）（P〉0．05）。A组中位无瘤生存时间为25．9个月，B组为21．7个月，A组总体无瘤生存率显著高于B组（P=0．035）。结论半肝血流完全阻断法可有效降低肝癌切除术后早期肺转移发生率并提高患者术后近期无瘤生存率，对预防术中肿瘤播散并改善患者预后有积极意义。Objective To study the efficacy of complete hemihepatic vascular exclusion （CHVE） in the prevention of tumour dissemination during liver resection for hepatocellular carcinoma （HCC）. Methods A case-control study was carried out on 281 patients who underwent liver resection for HCC between February 2006 and April 2010. 89 patients underwent hepatic resection using CHVE （group A） and 192 using Pringle maneuver （group B）. The postoperative 1-, 2-, 3-year rates of intra- hepatic recurrence and lung metastasis, and the overall disease-free survivals were compared between the two groups. Results The incidence of lung metastasis at 1 year after operation was significantly lower in group A than group B （6.7% vs. 15.1%, P=0. 048）. There were no significant differences in the incidences o{ lung metastasis at postoperative year 2 and 3 between the two groups （15.7 % vs. 25.0% and 32.6% vs. 30.7% ; P〉0.05）. The differences in the postoperative 1-, 2-, 3-year intra- hepatic recurrence rates were not significant between the two groups （20.2% vs. 31.8%, 51.7% vs. 60.3%, 68.5% vs. 79.2%, respectively; P〉0.05）. The median survivals of the two groups were 25.9 months and 21.7 months, respectively. Patients in group A had a significantly higher overall dis- ease-free survival rate than patients in group B （P=0. 035）. Conclusions CHVE was efficacious in reducing the incidence of lung metastasis and in improving the overall disease-free survival in patients after liver resection for HCC. CHVE contributed in preventing intraoperative tumour dissemination and in improving prognosis.

关 键 词：肝癌 肝切除术 血流阻断 肿瘤播散 预后 

分 类 号：R735.7[医药卫生—肿瘤]