54例复杂性肝癌手术治疗的临床分析  

Clinical analysis of the surgical treatment for the risk liver tumor in 54 cases

作　　者：依马木买买提江.阿布拉 易超[1] 苏雅婷[2] 李海军[1] 

机构地区：[1]新疆医科大学第三附属医院肝胆胰外科,新疆乌鲁木齐830000 [2]新疆医科大学第五附属医院,新疆乌鲁木齐830000

出　　处：《中国现代普通外科进展》2015年第9期695-700,共6页Chinese Journal of Current Advances in General Surgery

摘　　要：目的：探讨复杂性肝癌手术切除的安全性及预后因素。方法：回顾性分析2010年1月-2013年6月行手术切除的54例复杂性肝癌临床病理资料及手术方式。Kaplan-Meier法计算生存率,Log-rank法进行各组间的生存比较,Cox回归模型进行多因素分析。结果：手术均顺利切除,右半肝切除23例,左半肝切除21例,肝中叶切除10例,其中合并尾叶切除9例。第一肝门平均阻断（4.5±0.9）次[（31±9）min],术中出血量（703±201）mL。术后第5天ALT平均（93.9±32.2）IU/L,术后AFP降低率70.6%。术后并发症包括胆瘘3例,胸腔积液7例,膈下积液2例,腹腔感染2例,并发症发生率25.9%,经积极处理后均治愈。单因素分析提示：肝硬化程度、肿瘤有无包膜、有无癌栓、第一肝门阻断时间、出血量及术时等8项指标与预后有关;多因素分析得出五个独立预后因素为肝硬化程度、肿瘤有无包膜、门静脉或肝静脉有无瘤栓及术时。结论：积极的手术切除是治疗复杂性肝癌的主要措施。术前良好的评估、术中避免损伤肝门、术中合理血流控制、术后积极防治并发症是复杂性肝癌手术切除的安全保障。术后能否长期生存取决于肝硬化的程度、肿瘤有无包膜、门静脉或肝静脉有无瘤栓及术时。Objective：To explore the safety of the risk hepatectomy for liver tumor。Methods：The location and size of the risk liver tumor,the ways of resection,the intraoperative vascular exclusion,the blooded quantity,the ALT value after 5 days,the depressed AFP in 2 weeks and postoperative complications in 54 pathions between January 2010 and June 2013 were analysed retrospectively。Results：All operation was successful。Right hepatic resection was performed on 23 cases Jeft hepatic resection on 21 cases and central hepatic resection on 10 cases,which combineding caudate lobectomy were 9 cases。All cases were clamped the fist porta hepatis（Pringle＇s）。Occluding tape around vena cava was applied before central hepatic resection and caudate lobectomy,but only 5 cases were exclusive。The mean clamped times of Pringle＇s were about 33 minutes,the mean intraoperative blood loss about 1062 ml（300 □2200 ml）,the mean ALT value after 5 days was 101.4 IU/L and the depressed rates of AFP after 2 weeks were 70.6%。 The complication after operation was including bile leakage in 3 patients,hydrothorax occured in 7 patients,subphrenic abscess in 2 cases,and intra-abdominal infection in 2 patients,which were cured conservatively。There＇s no postperative hepatic failure occurred。The survival rates of 1,2,3 year were 84.7%。60.5%、20.2%respectively。Conclusions：The risk hepatectomy for liver tumor is quite difficult,but if we perform enough preoperative valuation,comprehend anatomy of liver,avoid to damage porta hepatis,be suitable for intraoperative vascular exclusion,and actively prevent postoperative complications,the risk hepatectomy for liver tumor is safe。

关 键 词：肝肿瘤 手术治疗 

分 类 号：R735.7[医药卫生—肿瘤]