精准肝蒂解剖法肝段切除术的临床疗效分析  

Precise hepatic pedicle dissection in anatomical hepatic segmentectomy

作　　者：祝根飞[1] 林建宇[2] 毛谅[2] 周铁[2] 仇毓东[2] 

机构地区：[1]浙江萧山医院普通外科,杭州311200 [2]南京大学医学院附属南京市鼓楼医院肝胆外科

出　　处：《中华肝胆外科杂志》2013年第5期343-348,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：本课题受国家传染病防治科技重大专项基金资助（2008ZX10002-26）

摘　　要：目的探讨采用精准肝蒂解剖法行肝段切除术的术前评估以及手术技术要点，并初步评估其疗效。方法采用前瞻性非随机对照研究的方法，将南京大学医学院附属鼓楼医院104例行解剖性肝段切除术的病例，按照手术方式分为精准肝蒂法组（44例，简称精准组）和常规切肝法组（60例，简称常规组）。比较两组临床资料及随访情况，并进一步对其中之原发性肝癌病例进行分层分析。结果（1）两组病例均无围手术期死亡。常规组与精准组两者术中出血量、输血量差异无统计学意义（P=0．069，0．208；t=1．844，1．266）；精准组人肝血流阻断率较高（P=0．001），人肝血流阻断时间和手术时间均延长，差异有统计学意义（P=0．001，0．001；t=3．849，3．574）。两组患者术后并发症率（P=0．988）、住院日（P=0．509；t=0．662）差异无统计学意义。（2）在原发性肝癌（包括肝细胞癌和肝内胆管细胞癌）患者，两组切缘阳性率、脉管阳性率及病理分期的差异无统计学意义（P=0．985，0．630，0．769）。（3）所有病例均获得2年随访，与常规组比较，精准组的无病生存时间（P=0．012）、总生存时间（P=0．006）、中位生存时间[（16．5±4．5）个月比（7．8±3．8）个月]均延长，差异有统计学意义。结论精准肝蒂解剖法可以达到和传统的肝切除术相同的治疗效果和安全性；对原发性肝癌在保证切缘的情况下，可以获得更好的预后。Objective To review the important points in the preoperative assessment and the surgical technique in precise hepatic pedicle dissection in anatomical hepatic segmentectomy. Methods 104 patients who underwent anatomical hepatic segmentectomy were divided into two groups according to the different surgical approaches adopted in a prospective and non-randomized manner： the precise hepatic pedicle dissection group （the precise group, n = 44） and the conventional hepatectomy group （the conventional group, n=60）. The perioperative and follow-up data were analyzed. Patients who had primary liver cancer, including hepatocellular carcinoma and intrahepatic cholangiocellular carcino- ma, were analyzed separately. Results （1） There was no perioperative death in the two groups. There was no significant differences in blood loss and transfusion between the 2 groups of patients （P=0. 069, 0. 208; t=1. 844, 1. 266）. There was a significantly higher rate of vascular inflow occlu- sion （P= 0. 001）. There were significantly longer periods of vascular inflow occlusion and operative time （P=0. 001, 0. 001; t=3. 849, 3. 574） in the precise group. There was no significant difference in postoperative complications （P= 0. 988） and the duration of postoperative hospital stay （P= 0. 509, t=0. 662） between the two groups. （2） In patients with primary liver cancer, there were no signifi- cant differences between the precise group （n=29） and the conventional group （n=41） in tumor mar- gin positivity, vascular invasion and pathological staging （P=0. 985, 0. 630, 0. 769）. （3） All patients were followed up for two years. When compared with the conventional group, the disease-free survival （P=0. 012）, overall survival （P = 0. 006）, and median survival （16.5 ± 4.5mo vs. 7.8 ± 3.8mo） were significantly longer in the precise group. Conclusion Precise hepatic pedicle dissection had the same safety and efficacy as conventional method in partial hepatectomy. For primary liver cancer,

关 键 词：肝脏病变 原发性肝癌 解剖性肝段切除 精准肝蒂解剖法 

分 类 号：R735.7[医药卫生—肿瘤]