精准肝脏外科理念在肝细胞肝癌治疗中的价值  

Clinical value of precision liver surgery concept in the treatment of hepatocellular carcinoma

作　　者：张松[1] 潘树波[2] 谢坤[1] 黄帆[1] 赵义军[1] 刘付宝[1] 赵红川[1] 王国斌[1] 耿小平[1,2] 

机构地区：[1]安徽医科大学第一附属医院器官移植中心,合肥230022 [2]安徽医科大学第二附属医院普通外科,合肥230601

出　　处：《安徽医科大学学报》2016年第1期94-97,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省卫生厅医学科研重点项目(编号:2010A009)

摘　　要：目的探讨精准肝脏外科理念在肝细胞肝癌(HCC)治疗中的应用价值,总结影响HCC切除术后复发的危险因素。方法回顾性分析行肝切除术的207例HCC患者的临床资料。结果精准手术组在血流阻断比例、平均血流阻断时间、平均手术时间、平均术中失血量、围手术期输血量、围手术期输血率、术后并发症发生率、术后住院时间等方面较传统手术组显著下降。传统手术组术后1、3、5年总体生存率分别为69%、37%、19%,中位生存时间34个月;精准手术组术后1、3年总体生存率分别为83%、54%,中位生存时间41个月。单因素分析显示:肿瘤直径>5 cm、血管侵犯、非R0切除、术中输血和肿瘤多发是肿瘤复发的危险因素。多因素分析显示:血管侵犯、非R0切除和术中输血是肿瘤复发的独立危险因素。结论精准肝脏切除术治疗原发性HCC是安全有效的,可改善患者生存预后。血管侵犯、切缘阳性和术中输血是影响HCC患者术后复发独立危险因素。Objective To investigate the clinical value of precision liver surgery concept in the treatment of hepato- cellular carcinoma（HCC） and analyze clinicopathologic risk factors associated with recurrence in patients with HCC after hepatectomy. Methods The clinical data of 207 patients with HCC were retrospectively analyzed. Results There were significant differences between the two groups in the rate of inflow occlusion, inflow occlusion time, op- eration time, volume of intraoperative blood loss, volume of blood transfusion, the rate of volume of blood transfu- sion,the complication rates and the duration of postoperative hospital stay. The 1-,3-,5-year survival rates and the overall median of the conventional routine hepateetomy group were 69%, 37% , 19% and 34 months; the 1-,3- year survival rates and the overall median of the precise liver resection group were 83% , 54% and 41 months. Uni- variate analysis showed that tumor more than 5 era, vascular invasion, non-R0 liver resection, blood transfusion and multiple lessons were the postoperative risk factors for recurrence. The use of Cox＇ s model of multivariate pro- portional hazard model indicated that significant risk factors for recurrence were vascular invasion, non-R0 liver re- section, blood transfusion. Conclusion Precision liver surgery is safe and effective in liver resection. The vascular invasion, non-R0 liver resection, blood transfusion are significant risk factors for recurrence of HCC. Key words

关 键 词：肝细胞肝癌 精准肝脏外科 肝切除 生存预后 

分 类 号：R619[医药卫生—外科学]