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目的分析原发性肝癌规则性肝切除和非规则性肝切除的围手术期因素,探讨原发性肝癌治疗中二者手术适应证。方法回顾性分析中国人民解放军空军总医院1990-2010年原发性肝癌中274例规则性肝切除术和586例非规则性肝切除术病人的临床资料。结果统计分析表明,规则性肝切除与非规则性肝切除相比,对术前病人肝功能状态要求更加严格,术中切除肝体积以及出血量、输血量均较非规则性肝切除组显著增多,手术时间延长,术后并发症发生率增加。但实施规则性肝切除术病人的肿瘤体积明显大于非规则性肝切除病人,切除肝段数目大于三段者所占比例亦显著高于非规则性肝切除组。结论对于<5cm的肝癌病人,采用非规则性肝切除保留更多功能性肝实质,可能更有利于病人术后恢复,减少相关并发症的发生。

Clinical study of regular hepatectomy and irregular hepatectomy in primary liver cancer

Objective To investigate surgical indication for primary liver cancer according to analyze operative and perioperative factors of regular hepatectomy and irregular hepatectomy. Methods The operative and perioperative factors of 274 cases of regular hepatectomies and 586 cases of irregular hepatectomies in primary liver cancer performed from 1990 to 2010 at Chinese PLA Air Force General Hospital were investigated retrospectively according to their medical documentation. Results Statistical analysis showed that the regular hepatectomy need a more stringent requirements in the liver function and more liver volume, blood loss, transfusion, moe operation time than the irregular hepatectomy. It also increased the rate of postoperative complications. But the tumor volume of regular hepatectomies was significantly greater than the irregular hepatectomies, and the proportion of three sections hepatectomy or more sections is significantly higher than the irregular hepatectomies. Conclusion For tumors less than 5cm of liver cancer, irregular hepatectomy can retain more functional liver parenchyma. Maybe it is more conducive to the recovery of patients after the operation and reduce the associated complications.