规则性或非规则性肝癌切除术治疗单发小肝癌的预后分析

目的分析规则性或非规则性肝癌切除术治疗单发小肝癌的预后情况。方法回顾性分析2009年2月至2014年2月我院诊治的58例单发小肝癌患者临床资料,将实施规则性切除术者纳入对照组(n=28),实施非规则性切除术者纳入观察组(n=30),术后均随访3年,比较两组手术时间、住院时间、术中出血量、切除肿瘤直径、切缘大小,测定两组手术前后血清白蛋白(Alb)、谷丙转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)水平,并对比术后1~3年内两组复发率、无瘤生存率、总生存率及并发症发生率。结果观察组手术时间(180.23±1.66)min短于对照组,观察组切除肿瘤直径(6.13±1.32)cm、切缘大小(2.71±0.15)cm小于对照组,两组住院时间、术中出血量比较无显著差异(P0.05);术后观察组血清Alb(32.18±1.06)g/L、ALT(26.29±0.11)μmol/L较对照组显著下降,观察组TBIL(18.29±1.33)μmol/L、DBIL(13.24±1.20)μmol/L明显高于对照组(P0.05);观察组术后1年、2年、3年复发率、无瘤生存率、总生存率与对照组同时点比较均无统计学意义(PO.05);观察组术后并发症发生率6.67%低于对照组28.57%(P0.05)。结论非规则性肝切除术治疗单发小肝癌具有手术时间短、切缘小、并发症发生率低优点,术后肝功能恢复较规则性肝切除术好,术后3年内复发率、无瘤生存率、总生存率与规则性手术比较无显著差异,值得在临床推广实践。

Prognosis of patients with single small hepatocellular carcinoma treated by regular or irregular hepatectomy

Objective To analyze the prognosis of patients with single small hepatocellular carcinoma (HCC) treated by regnlar or irregular hepatectomy.Methods The clinical data of 58 cases of patients with single small HCC diagnosed in the hospital during February 2009 ～ February 2014 were analyzed retrospectively.Patients treated by regular hepatectomy were included into the control group (n =28),while patients treated by irregular hepatectomy were included into the observation group (n =30).All patients were followed up for 3 years.The operation time,hospitalization time,intraoperative bleeding volume,dissected tumor diameter and incision margin size were compared between the two groups.Levels of serum albumin (Alb),alanine aminotransferase (ALT),total bilirubin (TBIL) and direct bilirubin (DBIL) in the two groups were determined.The recurrence rate,tumor free survival rate,overall survival rate and incidence of complications in the two groups in 1 ～ 3 years were compared.Results The operation time,tumor diameter and incision margin size of observation group were shorter than those of the control group.There was no significant difference in hospitalization time and intraoperative bleeding volume between the two groups (P ＞ 0.05).After operation,levels of serum Alb and ALT were significantly lower in observation group than the control group,while levels of TBIL and DBIL were significantly higher than the control group (P ＜ 0.05).There was no significant difference in 1-year,2-year and 3-year recurrence rates,disease-free survival rates and overall survival rates between the two groups at the same time (P ＞ 0.05).The incidence of postoperative complications was lower in the observation group than the control group (6.67％ vs 28.57％) (P ＜ 0.05).Conclusion Irregular hepatectomy has advantages of short operation time,small incision margin and low incidence of complications in the treatment of single small HCC.The liver function recovery after irregular hepatectomy is good than after rregular hepatectomy.The recurrence rate,disease-free survival and overall survival show no significant difference between the two methods.