肝癌介入后根治性精准肝切除的临床应用

目的:探讨根治性精准肝切除在肝癌介入后病例中应用的优势。方法:回顾性分析我院2005年1月至2012年12月间,肝癌介入治疗后行肝癌切除病例68例,其中采用传统Pringle法肝门阻断的肝切除术30例,根治性精准肝切除38例,比较两组在手术时间、术中出血量、术后肝功能损害、术后并发症及住院时间方面的差别。结果:根治性精准肝切除组手术时间(314.5±51.2)min长于Pringle法肝切除组(221.4±33.8)min,P<0.05。但根治性精准肝切除组较Pringle法肝切除组,术中出血少(375.4±76.8)vs(596.1±107.3)mL,P<0.05];术后肝功能损害轻,术后第3天,ALT:(311.7±44.3)vs(575.6±67.3)]U/L;AST:(172.3±35.7)vs(443.7±40.3)]U/L;TD:(41.2±13.2)vs(50.9±19.7)]μmol/L,差别均P<0.05;术后并发症发生率低(2/38,5.26%)比(8/30,26.67%),P<0.05;住院时间短(16.4±2.6)vs(22.7±5.1)]d,P<0.05。结论:根治性精准肝切除运用于肝癌介入后病例中,相对传统Pringle法肝门阻断肝切除术有着术中出血少、肝功能损害轻、并发症发生率低、住院时间短的优势。

Clinical application of radical precise hepatectomy for liver cancer after interventional therapy

Objective：To discuss the advantage of radical precise hepatectomy of liver cancers after interventional therapy. Methods： Retrospectively analyzed the clinical data of 68 patients who had received hepatectomy of liver cancers after interventiona] therapy in our hospital during Jan. 2005 to Dec. 2012;Radical precise hepatectomy were performed in 38 cases （precise hepatectomy group）and the traditional pringle maneuver for liver portal triad clamping were performed in 30 cases （pringle clamping group）. Then the surgery time, blood loss, postoperative liver function impair, complications, hospital stays between the precise hepateetomy group and pringle clamping group were compared. Results：The surgery time of the precise hepatectomy group was longer than the pringle clamping group（314. 5 ± 51.2rain vs 221.4 ± 33.8rain P 〈 0. 05 ）. But compared with the pringle clamping group,the precise hepatectomy group had less blood loss（375.4±76.8ml vs 596. 1 ± 107.3ml,P 〈0. 05） ,less postoperative liver function impair（on 3rd day after operation,ALT：311.7 ±44. 3U/L VS 575.6 ±67.3U/L;AST：172.3 ＋35.7U/L vs 443.7 ±40. 3U/L;TD：41.2 ±13.2pLmol/L vs 50. 9 ± 19. 7μmol/L,P 〈 0.05） ,less complications（ 2/38,5.26% vs 8/30,26.67% , P 〈 0. 05 ） and less hospital stays （ 16.4 ± 2. 6d vs 22. 7 ± 5. ld, P 〈 0. 05 ）. Conclusion：For patients with liver cancers after interventional therapy, radical precise hepatectomy shows more advantages com- pared with traditional tingle clamping hepatectomy in blood loss,postoperative liver function impair,complications and hospital stays.