原发性肝癌术后肝功能变化临床分析

目的探讨原发性肝癌病人手术前后肝功能变化规律。方法回顾性分析1990—2005年收治的142倒原发性肝癌，按术前肝功能Child分级分为2组。ChildA级102例（A组），ChildB级40例（B组）。分析比较两组病人手术前、后的主要肝功能指标变化。结果原发性肝癌病人丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和血清胆红素于手术后均升高，术后3d迭较高水平，后呈现逐渐下降的趋势。A、B两组在升高幅度及下降趋势上差异有显著性，肝功能ChildA级病人2周后上述指标恢复到术前水平。结论原发性肝癌病人手术前、后的主要肝功能指标变化与术前肝功能Child分级密切相关。     

原发性肝癌切除术后发生肝功能代偿不全的临床研究

目的: 探讨了解肝部分切除术后出现肝功能不全的可能原因. 方法: 将63例原发性肝癌患者分成3组,比较分析各组的手术后生存时间与生存率、术后复发率、术前、术后的主要肝功能指标,术后一年内出现肝功能不全的原因与频率,以及死亡患者的死亡原因与时间等. 结果: 平均随访时间为(25±21.3)个月,各组生存率无显著性差异,总复发率为56%(35/63),平均复发时间为17个月;术后死于复发癌的时间为(22±12.3)个月,死于肝功能不全的时间为(4.8±3.7)个月,术前肝功能储备差者,术后易发生代偿不全,术后早期死亡者大多由肝功能不全所致. 结论: 对原发性肝癌病人行肝部分切除术时,要充分了解肝功能储备,术后早期积极给予保肝治疗.     

门冬氨酸鸟氨酸对肝硬化肝癌术后肝功能的影响

目的：观察门冬氨酸鸟氨酸（LOLA）对肝癌合并肝硬化半肝切除术后肝功能的影响。方法：通过随机、对照的方法,将66例肝癌合并肝硬化行半肝切除患者分为2组,仅治疗组于术后1～7 d静脉应用LOLA。全部患者分别在术前及术后1、3、5、7、10、14 d抽外周静脉血检查谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TB）、直接胆红素（DB）。结果：治疗组术后1、3、5 d ALT明显低于对照组（P〈0.05）,术后3、5 d AST明显低于对照组（P〈0.05）。治疗组术后7 d ALT恢复正常的比率高于对照组。LOLA对术后TB、DB无影响。两组术后肝功能不全的发生率无差异（P=0.557）。结论：LOLA能促进肝癌肝硬化半肝切除术后肝脏功能的早期恢复。     

肝癌肝切除术后肝功能衰竭的防治

目前，原发性肝癌（下称肝癌）的最有效治疗方法是肝叶切除。由于肝癌合并肝硬变者高达85．5％’‘’，故肝叶切除术后肝功能衰竭的发生率较高，也是术后引起死亡的主要并发症之一。我院于1990年1月至1997年8月期间因肝癌行肝叶切除者2150例。术后因肝功能衰竭死亡者11例，占0．51％。有效防治肝癌肝切除术后肝功能衰竭是减少肝癌手术并发症降低手术死亡的重要环节。1！陆床资料1990年1月至1997年8月，我院收治肝癌行肝叶切除者2150例。其中术后死于肝功能衰竭者11例；上消化道出血并发肝功能衰竭者8例，共19例。男17例，女2例。年龄38～65…     

洛铂腹腔灌注化疗对原发性肝癌术后患者肝功能及预后的影响研究

目的 探讨洛铂腹腔灌注化疗对原发性肝癌术后患者肝功能及预后的影响。方法 选取2021年7月至2022年2月广西医科大学附属武鸣医院收治的92例原发性肝癌患者,以随机数字表法分为对照组和观察组,各46例。对照组给予开腹或腹腔镜肝肿瘤切除术,观察组在对照组的基础上给予洛铂腹腔灌注化疗,术后均随访6个月。比较两组术前、术后7d、术后1个月、术后2个月的血清甲胎蛋白(alpha-fetoprotein,AFP)及丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、总胆红素(total bilirubin,TBIL)水平,并评价两组患者术后6个月内的预后不良发生情况。结果 术后2个月,两组患者血清AFP水平随时间逐渐下降,且术后7d、1个月、2个月,观察组血清AFP水平均低于对照组,差异均有显著性(P <0.05)。术后2个月,两组患者血清ALT、AST水平低于术前,差异有显著性(P <0.05);但术后7d、1个月、2个月两组血清ALT、AST、TBIL水平比较,差异均无显著性(P>...     

可切除大肝癌术前TACE对手术前后肝功能的影响

目的 探讨可切除大肝癌术前TACE对手术前后肝功能的影响。方法 分析2002年1月至2003年1月78例可切除大肝癌患者，其中31例术前行TACE，47例术前未经TACE(对照组)。分析两组术前肿瘤大小、肝功能指标变化、手术探查情况及手术相关因素、术后肝功能指标变化及并发症情况的差异。结果 TACE组术前7-球蛋白水平升高，术后前白蛋白水平下降，手术探查见肿瘤周围粘连明显增加，肝硬化加重，手术时间延长。两组间肝门阻断时间、术中平均出血量、术后并发症等指标无显著差异，TACE组TACE后平均肿瘤直径缩小并不显著。结论 大肝癌术前TACE使肝功能受损，增加手术难度及手术风险，并有可能耽误手术时机。     

原发性肝癌合并肝硬化肝切除术后肝功能衰竭的临床分析

目的探讨原发性肝癌合并肝硬化术后发生肝功能衰竭的危险因素和手术经验总结。方法回顾性分析2006年1月至2009年12月我院82例原发性肝癌伴有肝硬化行肝切除患者的临床资料。结果术后发生肝功能衰竭7例,单因素分析示:肝功能Child-Pugh分级、围手术期PA血清值、癌灶大小、肝硬化程度、术中失血量、手术方式及手术时间与术后肝功能衰竭有密切关系。结论对于合并肝硬化的肝癌患者,术前评估肝脏储备功能、缩短手术时间、控制术中出血及保护残余肝脏功能是预防术后发生肝功能衰竭的有效措施。     

原发性肝癌肝切除治疗现状

原发性肝癌肝切除治疗现状陈孝平在我国，原发性肝癌是最常见的恶性肿瘤之一。据近年来的统计资料显示，其发病率仍在不断上升，在有些地区，本病已在男性人群恶性肿瘤死亡原因中居第一位。Ｋｅｗ（１９８７）统计了５８５例，平均生存期仅１．５个月。近年来，国内外在以...     

原发性肝癌切除术后胸水成因的临床研究

肝癌切除术后常见并发症之一是右侧胸水形成 ,其后果可致患者低氧血症甚至呼吸功能不全 ,从而影响全身功能[1] 。本文初步探讨了原发性肝癌切除术后右侧胸水的部分成因及对策。1　材料与方法1 .1　取本院住院患者 ,在进行手术探查时证实为原发性肝癌 ,并行肝部分切除术的 1 0 4例为对象进行了回顾性研究。右侧胸腔积液者术后经影象学检查证实。1 .2　分组与观察指标根据有无术后胸水将 1 0 4例患者分两组。有胸水者 35例为 G1组 ( n=35 ) ,无胸水者 69例为 G2组 ( n=69)。将术中进行了右肝三角韧带与冠状韧分离的 78例患者 ,再根据有无胸水…     

原发性肝癌极量肝切除的确定

目的：探讨原发性肝癌(简称肝癌)患行极量肝切除的指征和安全性。方法：2000年11月至2002年10月行极量肝切除治疗原发性肝癌共33例，合并肝硬化26例，分析评估肝癌极量肝切除的术前各项指标、术中处理和术后恢复情况。结果：全组无手术死亡，术后并发症发生率为33．3％，经及时治疗后均顺利恢复。结论：肝脏储备功能良好的肝癌患，在保证切肝量不超过肝组织量的50％的基础上，尽可能多地保留肝组织，术后加强残肝功能保护，及时处理并发症，肝癌行极量肝切除仍然是安全的。     

A review of the prognostic factors in patients with recurrence after liver resection for hepatocellular carcinoma

BACKGROUND: Liver transplantation achieves better results when hepatocellular carcinoma fits the Milan criteria. This study investigated predictors of recurrent hepatocellular carcinoma exceeding the Milan criteria. METHODS: Among 285 patients with hepatocellular carcinoma fitting the Milan criteria who underwent curative resection, 143 patients suffered initial recurrence (92 had tumors fitting the criteria) and 71 patients suffered a second recurrence (40 conforming tumors). RESULTS: Survival after hepatectomy was significantly worse when initial recurrence was nonconforming. Similarly, survival after initial recurrence was significantly worse when the second recurrence was nonconforming. A preoperative increase of protein induced by vitamin K absence/antagonist II, a tumor diameter of 3 cm or greater, age of 65 years or younger, and intraoperative blood transfusion increased the risk of nonconforming initial recurrence. CONCLUSIONS: Liver transplantation should be considered initially for younger patients with hepatocellular carcinoma fitting the Milan criteria, larger tumors, and an increase of protein induced by vitamin K absence/antagonist II.     

Comparison of hepatic resection and hepatic transplantation in the treatment of hepatocellular carcinoma among cirrhotic patients

Background The benefits of hepatic transplantation (HT) compared with hepatic resection (HR) in treating hepatocellular carcinoma (HCC) in patients with cirrhosis are controversial. The aim of this study was to compare the results of these therapeutic options. Methods The charts of all patients with cirrhosis who underwent HR or HT for HCC between 1997 and 2000 were analyzed. Results The cohort included 44 patients who underwent HR compared with 65 with HT. All patients in the HR group had Child's A disease, in contrast to the HT group, which included 23% Child's A and 77% Child's B and C patients. Whereas all HT patients spent at least three nights in the intensive care unit, 41% of the HR group never required critical care. Perioperative mortality was 7% in both groups. Pathologic analysis revealed T1/T2 disease in 43% of the HR group compared with 75% of the HT group. After 36 months of follow-up, there was no significant difference in overall survival (57% vs. 66%) or disease-free survival (36% vs. 66%) between the two groups. Conclusions With overall survival and disease-free survival as the main outcomes, the results of HR versus HT are comparable in Child's A patients with HCC. In this patient subset, HR not only is an effective form of therapy, but is also associated with quicker recovery.     

Laparoscopic hepatic resection for hepatocellular carcinoma

Despite recent progress in diagnostics for hepatocellular carcinoma, the rate of resectability remains low, mainly because of the advancement of the underlying liver disease. We report a case of a 54-year-old man with a hepatocellular carcinoma and poor liver function that was treated successfully with a laparoscopic hepatic resection. Laparoscopic hepatic resection is considered to be feasible with the aid of an ultrasonic dissector and a microwave coagulator; however, close attention should be paid to the development of air embolism and hepatic vein injury.     

肝癌切除围手术期肝脏贮备功能的研究

绝大部分肝细胞性肝癌病人合并肝硬化。常规肝功能检查对估计肝硬化病人肝切除时围手术期肝脏贮备功能存在明显不足。我们通过动物实验和临床观察，研究嘴哚氰绿５分钟潴留率（ＩＣＧＲ１５）、精氮酸清除率（Ａｒｇ－ＣＲ）、利多卡因代谢（ＬＩＤ）、肝实持切除率（ＰＨＲＲ）和动脉血酮体幽会在反映肝功能状态上的实际价值，并根据临床结果进行了综合评定。结果表明上述指标有助于及时地准确了解病人的肝脏功能状态、并提出了术前     

原发性肝癌术后超声引导下经皮经肝门静脉穿刺化疗安全性分析

目的 研究原发性肝癌术后超声引导下经皮经肝门静脉穿刺化疗安全性.方法 总结2004年1～10月实施的原发性肝癌术后行超声引导下经皮经肝门静脉穿刺化疗病例,分析其术后常见并发症及其预防及处理措施.结果 共有524例原发性肝癌病人在肝切除手术后接受了超声引导下经皮经肝门静脉穿刺化疗,累及实施1865例次.共发生穿刺操作相关性并发症149例次,并发症发生率为79.89‰(149/1865),其中包括术后穿刺点疼痛118例次(118/1865,63.27％0),肝包膜下出血3例次(3/1865,1.61‰),腹腔出血2例次(2/1865,1.07‰),胆汁漏6例次(6/1865,2.54‰),门静脉血栓形成8例次(8/1865,4.29％0),导管相关性感染4例次(4/1865,2.14‰),气胸3例次(3/1865,1.61％0),导管脱落5例次(5/1865,2.68‰).化疗相关并发症587例次(587/1865,31.47％),其中包括胃肠道不良反应385例次(385/1865,20.64％),白细胞减少121例次(385/1865,20.64％),转氨酶升高62例次(62/1865,3.32％),皮疹11例次(11/1865,5.90％),其他8例次(8/1865,4.29％).所有并发症经保守治疗后均痊愈,未有致死性并发症.结论 肝癌术后超声引导下经皮经肝门静脉穿刺化疗操作简单、安全,术后并发症发生率在可接受范围.     

A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinoma

Background  A novel index, the serum aspartate aminotransferase activity/platelet count ratio index (APRI), has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. We evaluated the ability of preoperative APRI to predict hepatic failure following liver resection for hepatocellular carcinoma. Methods  Potential preoperative risk factors for postoperative hepatic failure (hepatic coma with hyperbilirubinemia, four patients; intractable pleural effusion or ascites, 30 patients; and variceal bleeding, one patient) as well as APRI were evaluated in 366 patients undergoing liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses. Results  Hepatic failure developed postoperatively in 30 patients, causing death in four. APRI correlated with histological intensity of hepatitis activity and degree of hepatic fibrosis, and was significantly higher in patients who developed postoperative hepatic failure than in others without failure. Risk of postoperative hepatic failure increased as the serum albumin concentration and platelet count decreased and as indocyanine green retention rate at 15 min, aspartate and alanine aminotransferase activities, and APRI increased. Only APRI was an independent preoperative factor on multivariate analysis. Of the four patients who died of postoperative hepatic failure, three had an APRI of at least 10. Conclusions  Preoperative APRI independently predicted hepatic failure following liver resection for hepatocellular carcinoma. Patients with an APRI of 10 or more have a high risk of postoperative hepatic failure.     

乙肝病毒因素对肝癌肝切除及肝移植术后复发的影响

肝切除术是目前公认的治疗肝癌的首选方式,但术后肿瘤复发率较高.中国肝癌患者多数合并乙肝感染,乙肝病毒(HBV)因素如:病毒基因型、血清e抗原状态、血清HBV DNA水平、肝内HBV DNA水平与肝切除术后肿瘤复发相关.抗病毒治疗,尤其是干扰素治疗可能是预防肝癌复发的有效方式之一.乙肝病毒因素也可影响肝移植术后患者复发率.     

Liver stiffness measurement predicts short-term and long-term outcomes in patients with hepatocellular carcinoma after curative liver resection

Background and aimHepatocellular carcinoma is one of the commonest cancer in the world. Despite curative resection, recurrence remains the largest challenge. Many risk factors were identified for predicting recurrence, including liver fibrosis and cirrhosis. Transient elastography (Fibroscan) is an accurate tool in measuring liver fibrosis. This study aimed to evaluate the use of preoperative liver stiffness measurement (LSM), with Fibroscan in predicting long-term recurrence of hepatocellular carcinoma (HCC) after curative resection.MethodA prospective cohort study was conducted from February 2010 – June 2017 in Prince of Wales hospital. All consecutive patients with HCC undergone hepatectomy were included. Demographic factors, preoperative LSM, tumor characteristics and operative details were assessed. Primary outcome and secondary outcome were overall survival and disease free survival at 1 year, 3 year and 5 year respectively.ResultsA total of 401 cases were included. Patients with LSM ≥12kPa had significantly lower 5-year overall survival rate (75.1% vs 57.3%, p < 0.001) and disease free survival rate (45.8% vs. 26.7%, p < 0.001). On multivariate analysis, pre-operative creatinine and vascular invasion of tumor were significant factors in predicting early recurrence (p = 0.012 and p = 0.004). LSM ≥12kPa were the only significant factor in predicting late recurrence (p = 0.048).ConclusionPre-operative liver stiffness measurement could predict the late recurrence of hepatocellular carcinoma after curative resection.     

Long-term surgical outcomes in patients with hepatocellular carcinoma undergoing laparoscopic vs. open liver resection: A retrospective and propensity score-matched study

Background/objectivesThere is limited availability of well-designed comparative studies using propensity score matching with a sufficient sample size to compare laparoscopic liver resection (LLR) vs. open liver resection (OLR) for hepatocellular carcinoma (HCC). We aimed to compare the feasibility and safety of LLR and OLR in patients with HCC.MethodsWe enrolled 168 patients who underwent elective LLR (n = 58) or OLR (n = 110) for HCC in two tertiary medical centers between November 2009 and December 2018. Patients who underwent LLR were propensity score-matched to patients who underwent OLR in a 1:1 ratio. Perioperative and postoperative outcomes and disease-free and overall survival rates were prospectively evaluated.ResultsAmong the 116 patients analyzed, 58 each belonged to the LLR and OLR groups. We performed 85 segmentectomies or sectionectomies, 19 left-lateral-sectionectomies, 9 left-hemihepatectomies, and 3 right-hemihepatectomies. There was no significant difference in age, sex, Child-Pugh class, original liver disease, preoperative alpha-fetoprotein, tumor size, tumor location, overall morbidity, and operative time. There was a significant difference in the length of postoperative hospital stay between the two groups (LLR vs OLR; 8 vs 10 days, p = 0.003). The 1-, 3-, and 5-year overall survival rates in the LLR and OLR groups were 96.6%, 92.8%, and 73.3% and 93.1%, 88.8%, and 76.1%, respectively (p = 0.642). The 1-, 3-, and 5-year disease-free survival rates in the LLR and OLR groups were 84.4%, 64.0%, and 60.2% and 93.1%, 67.4%, and 63.9%, respectively (p = 0.391).ConclusionLLR for HCC can be performed safely with acceptable short-term and long-term outcomes compared with OLR.     

伴有门静脉高压症的早期肝癌病人肝切除与微波消融的疗效比较

目的通过对病毒性肝炎相关的早期肝癌合并门静脉高压症病人肝切除与微波消融的疗效比较,探究肝切除的疗效和安全性。方法回顾性分析2012年1月至2016年7月收治的89例病毒性肝炎相关的巴塞罗那分期早期肝癌合并门静脉高压症的病人,将病人分为肝切除组(41例)及微波消融组(48例),并分析预后的影响因素、比较两组的术后生存率。结果肝切除组肿瘤直径大于消融组,分别为(3.6±1.7)cm和(2.4±0.95)cm,P=0.01。而肝脏储备功能肝切除组则优于微波消融组(吲哚菁绿15 min滞留率10%),分别为19%和66.7%,P=0.01,经由单因素和多因素分析,术前甲胎蛋白(AFP)400μg/L(P=0.019)及围手术期输血(P=0.001)是全部89例早期肝癌合并门静脉高压症病人术后总生存期的独立危险因素,尽管两组的术后总生存期相似(P=0.908),但肝切除组在术后累积肿瘤无复发生存期上具有比微波消融组更好的预后(P=0.033)。结论肝切除对具有良好肝脏储备功能的巴塞罗那早期肝癌伴门静脉高压症病人是一种安全、有效的治疗选择,而微波消融治疗则适用于肝脏储备功能较差的小肝癌病人。