以第三级肝蒂为主导的解剖性肝段切除与非解剖性肝切除对肝癌患者的疗效比较研究  

Comparative study on the efficacy of anatomic segmentectomy and non-anatomic segmentectomy with the third hepatic pedicle in patients with hepatocellular carcinoma

作　　者：胡斌 赵伟 宦宏波 朱自满 韩明明 涂玉亮 王大东 蔡守旺 Hu Bin;Zhao Wei;Huan Hongbo;Zhu Ziman;Han Mingming;Tu Yuliang;Wang Dadong;Cai Shouwang(Department of Hepatobiliary Surgery,The Fourth Medical Centre of Chinese PLA General Hospital,Beijing 100048,China;Department of Hepatobiliary Surgery,The First Medical Centre of Chinese PLA General Hospital,Beijing100853,China)

机构地区：[1]中国人民解放军总医院第四医学中心肝胆胰外科,北京100048 [2]中国人民解放军总医院第一医学中心肝胆外科,北京100853

出　　处：《中华普外科手术学杂志（电子版）》2022年第6期618-621,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：首都市民健康项目培育(Z151100003915155)。

摘　　要：目的研究以第三级肝蒂为主导的解剖性肝切除(AR)和非解剖性肝切除(NAR)对肝癌患者预后的影响。方法回顾性分析2015年7月至2017年12月期间89例行肝切除术的原发性肝癌患者的临床数据,根据手术方式不同,分为AR组(n=45)和NAR组(n=44)。数据采用SPSS22.0软件进行处理,两组患者围手术期指标和肝酶谱变化以(x±s)表示,采用独立t检验;术后并发症、切缘阳性率等采用χ^(2)或Fisher精确检验;术后复发率采用对数秩检验进行统计分析。P<0.05差异有统计学意义。结果AR组患者出血量、手术切缘阳性率明显低于NAR组(出血量:414mlus.973ml,P<0.01;切缘阳性率:0%us.10%,P=0.056),术后6、12个月复发率明显低于NAR组(6.7%vs.20.5%,P=0.058;15.6%us.40.9%,P=0.008);AR组手术时间明显长于NAR组(325minus.270min,P=0.041);AR组患者术后肝功能受影响小(P<0.01),两组比较均有统计学意义;术后严重并发症的发生率两组差异无统计学意义(P>0.05)。结论相比于非解剖性肝切除,以第三级肝蒂为主导的解剖性肝切除治疗肝癌,患者术中出血量少、术后肝功能受影响小、术后复发率低,是更为合适的手术方式。Objective To investigate the effect of anatomic hepatectomy(AR)and non-anatomic hepatectomy(NAR)led by the third liver pedicle on the prognosis of liver cancer patients.Methods The clinical data of 89 patients with primary liver cancer who underwent hepatectomy from July 2015 to December 2017 were retrospectively analyzed.According to dfferent surgical methods,they were divided into AR group(n=45)and NAR group(n=4).The data were processed by SPSS 22.0 software.The perioperative indicators and liver zymogram changes of the two groups were expressed as(x±s),and independent t test was used.χ^(2)or Fisher exact test was used for postoperative complications and positive rate of surgical margin.The postoperative recurrence rate was analyzed by Log-Rank test.P<0.05 was statistically significant.Results The blood loss and positive rate of surgical margin in AR group were significantly lower than those in NAR group(blood loss:414 ml us.973 ml,P<0.01;The positive rate of surgical margin was 0%us.10%,P=0.056),and the recurrence rate at 6 and 12 months after surgery was significantly lower than that in the NAR group(6.7%us.20.5%,P=0.058;15.6%us.40.9%,P=0.008);The operation time in AR group was significantly longer than that in NAR group(325 min us.270 min,P=0.041).The liver function of AR group was less ffected after operation(P<0.01),and the comparison between the two groups was statistically significant.There was no significant dfference in the incidence of postoperative serious complications between the two groups(P>0.05).Conclusion Compared with non-anatomical hepatectomy,anatomical hepatectomy led by the third hepatic pedicle is a more appropriate surgical method for the treatment of liver cancer,with less intraoperative blood loss,less postoperative liver function impact,and lower postoperative recurrence rate.

关 键 词：肝肿瘤 解剖性肝切除术 非解剖性肝切除术 复发 

分 类 号：R657.3[医药卫生—外科学] R735.7[医药卫生—临床医学]