精准肝脏外科理念和技术对大范围肝切除围手术期安全性的影响  

Effects of concept and techniques of precision liver surgery on the perioperative safety of patients under- going major hepatectomy

作　　者：董家鸿[1] 唐茂盛[1] 张文智[1] 姜凯[1] 史宪杰[1] 蔡守旺[1] 段伟东[1] 黄志强[1] 

机构地区：[1]解放军总医院肝胆外科医院、全军肝胆外科研究所,北京100853

出　　处：《中华消化外科杂志》2013年第5期344-351,共8页Chinese Journal of Digestive Surgery

基　　金：国家科技部科技支撑计划项目（2012BAI06801）

摘　　要：目的评价精准肝脏外科理念和技术对大范围肝切除围手术期安全性的影响。方法回顾性分析1986年1月至2012年1月解放军总医院1250例行大范围肝切除（≥3个肝段）肝病患者的临床资料。按照收治的时间将患者分为传统手术组（459例,1986年1月至2006年12月）与精准手术组（791例,2007年1月至2012年1月）。比较两组患者的围手术期情况,分析影响并发症发生率和病死率等相关的危险因素。采用门诊。信件及电话随访,随访时间截至2012年12月。计量资料采用独立样本t检验,非正态分布的数据采用非参数MannWhitneyU检验,计数资料采用χ2检验。单因素分析采用χ2检验,多因素分析采用二元Logistic回归分析。采用KaplanMeier法计算患者生存率,生存分析采用Logrank检验。结果传统手术组规则性肝切除术和不规则性肝切除术所占比例分别为62.31%（286/459）和37.69%（173/459）,精准手术组分别为85.59（677/791）和14.41%（114/791）,两组比较,差异有统计学意义（χ2=88.98,88.98,P〈0.05）。传统手术组右半肝切除术。左半肝切除术。扩大左半肝切除术所占比例分别为18.52%（85/459）。29.85%（137/459）和3.05（14/459）,低于精准手术组的28.45%（225/791）。37.67%（298/791）和6.32%（50/791）,两组比较,差异有统计学意义（χ2=15.35,7.84,6.40,P〈0.05）。传统手术组采用Pringle法入肝血流阻断和选择性血流阻断的比例分别为66.01%（303/459）和12.42%（57/459）,精准手术组分别为27.18%（215/791）和31.73%（251/791）,两组比较,差异有统计学意义（χ2=180.49,58.35,P〈0.05）。传统手术组手术时间。术中中位出血量。术中输血率。术后住院时间。术后并发症发生率和病死率分别为（291±124）min。750ml。62.75%（288/459）。（18±14）d。26.36%（121/459）和3.49%（16/459）,精准手术组分别为（337±142）min。550ml。35.40%（280/791）。（14±9）dObjective To evaluate the effects of concept and techniques of precision hepatic surgery on the perioperative safety of patients who received major hepatectomy. Methods The clinical data of 1250 patients with hepatic diseases who received major hepatectomy at the Chinese PLA General Hospital from January 1986 to January 2012 were retrospectively analyzed. All the patients were divided into 2 groups, 459 patients who were admitted from January 1986 to December 2006 were in the traditional surgery group, and 791 patients who were admitted from January 2007 to January 2012 were in the precision surgery group. The perioperative conditions of the patients in the 2 groups were compared, and the risk factors of morbidity and mortality were analyzed. The patients were followed up via outpatient examination , mail or telephone till December 2012. The measurement data, nonnormal data and count data were analyzed using independent sample t test, nonparametric MannWhitney U test and chisquare test, respectively. The univariate and multivariate analysis were done using the chisquare test and bivariate Logistic regression analysis, respectively. The survival rates were calculated by using the KaplanMeier method, and the survival was analyzed using the Logrank test. Results The ratios of anatomical hepatectomy and unanatomical hepatectomy were 62.31%（286/459） and 37.69%（173/459） in the traditional surgery group, and 85.59%（677/791） and 14.41%（114/791） in the precision surgery group, with significant difference between the 2 groups （X2=88.98, 88.98, P〈0.05）. The ratios of right hemihepatectomy, left hemihepatectomy and extended left hemihepatectomy were 18.52%（85/459）, 29.85%（137/459） and 3.05%（14/459） in the traditional surgery group, which were significantly lower than 28.45%（225/791）, 37.67%（298/791） and 6.32%（50/791） in the precision surgery group （X2=15.35, 7.84, 6.40, P〈0.05）. The ratios of hepatic inflow occlusion with Pringle maneuver and se

关 键 词：肝脏疾病 精准肝脏外科 肝切除术 并发症 病死率 

分 类 号：R735[医药卫生—肿瘤]