术前介入治疗对肝细胞癌患者围手术期转归的影响  

Effect of preoperative transcatheter arterial on the perioperative outcome of patients with hepatocellular carcinoma

作　　者：荣维淇[1] 余微波[1] 吴凡[1] 吴健雄[1] 王黎明[1] 田斐[1] 安松林[1] 冯莉[1] 刘发强[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院腹部外科,100021

出　　处：《中华肿瘤杂志》2015年第9期671-675,共5页Chinese Journal of Oncology

摘　　要：目的探讨术前行介入治疗的肝细胞癌（HCC）患者手术风险、围手术期转归及应对措施。方法采用回顾性病例配对研究的方法，比较术前介入治疗组与未行介入治疗的配对对照组患者的围手术期转归特点及应对措施。共纳入手术患者105例（其中82例患者采用肝区域选择性适时血流阻断的方法行复杂肿瘤的肝切除），按1：2配对，介入治疗组患者35例，配对对照组患者70例。结果介入治疗组患者术前γ-谷氨酰转肽酶水平为（119．52±98．83）U／L，明显高于配对对照组[（67．39±61．25）U／L，P=0．040]。介入治疗组患者的手术时间为（232．60±95．43）min，较配对对照组[（218．70±75．13）]min延长，但差异并无统计学意义（P=0．052）。介入治疗组患者术后肝功能的恢复情况与配对对照组患者的差异无统计学意义（均P〉0．05）。介入治疗组和配对对照组患者均无大出血、胆瘘和30d内死亡病例。结论术前介入治疗对HCC患者的肝功能有一定的不利影响，应用肝区域选择性适时血流阻断的方法及合理的围手术期治疗，能够保障HCC患者手术的安全性，促进患者的快速康复。Objective To explore the surgical risk, perioperative outcome and the response of patients with hepatocellular carcinoma （HCC） after preoperative transcatheter arterial chemoembolization （TACE）. Methods A retrospective case-matched study was conducted to compare the characteristics and corresponding measures of patients in the preoperative TACE group and the control group without TACE. A total of 105 patients （ 82 patients with selective and dynamic region-specific vascular occlusion to perform hepatectomy for patients with complex hepatocellular carcinoma） was included in this study, in which 35 patients underwent TACE therapy, and a 1 ： 2 matched control group of 70 subjects. Results The patients of preoperative TACE therapy group had a higher level of γ-glutamyl transpeptidase before operation （ 119.52± 98.83） U/L vs. （67.39±61.25） U/L （P= 0.040）. The operation time was longer in the TACE group than that in the control group but with a non-significant difference （232.60±95.43） min vs. （218.70±75.13） min （P=0.052）. The postoperative recovery of liver function and severe complications in the preoperative TACE group were similar to that in the control group （P〉0.05）. There were no massive hemorrhage, biliary fistula and 30-d death neither in the treatment group and matched control group. Conclusions Preoperative TACE therapy has certain negative effect on liver function. It is preferable to use selective and dynamic region- specific vascular occlusion technique during hepatectomy and combine with reasonable perioperative treatment for this group of patients, that can ensure safety of patients and promote their rapid recovery.

关 键 词：癌 肝细胞 肝切除术 肝动脉化疗栓塞 肝功能 

分 类 号：R735.7[医药卫生—肿瘤]