解剖性分离方法在肝切除术中的临床应用

目的探讨降低肝癌肝切除术后并发症和死亡率的有效途径。方法回顾性分析398例肝脏恶性肿瘤患者的临床资料,其中243例采用解剖性分离方法(A组)进行肝切除;155例采用传统钳夹法(B组)进行肝切除。围手术期常规保肝治疗。比较2组术中出血及输血情况、术后肝功能、并发症发生率、手术死亡率以及住院时间。结果A组肿瘤直径(6.02±3.24)cm,术中出血量(445±240)ml,输血52例(24.3%),输血量(520±280)ml。无手术死亡及腹腔出血、肝功能衰竭等严重并发症,轻度并发症12例(4.9%),术后住院时间为(13.4±4.9)d。B组肿瘤直径(5.84±2.93)cm,术中出血量(1 200±320)ml,输血53(34.2%)例,输血量(1 400±623)ml。手术后30d内死亡5例(3.23%),发生并发症25例(16.1%),其中术后腹腔或肝创面出血5例、肝功能衰竭5例。术后住院时间(18.9±10.3)d。A组术中出血量、输血量、手术死亡率、术后严重并发症发生率、总并发症发生率、术后住院时间均显著低于B组(P<0.05,P<0.01)。结论在积极的围手术期处理同时,采用解剖性分离方法进行肝切除,可以显著降低肝癌肝切除手术并发症和死亡率。

Clinical application of anatomic method of separation in hepatectomy

OBJECTIVE: To investigate the effectiveness of anatomic method of separation in hepatectomy methods of decreasing postoperative complication and mortality for liver cancer patients. METHODS: The clinical data of 398 patients with liver malignant tumors, admitted in our hospital during 2001 to 2007, were retrospectively analyzed. The anatomic method group (group A) included 243 contiguous patients of liver cancer who received hepatectomy by anatomical method of separation, while the traditional method group (group B) included 155 patients of liver cancer who received hepatectomy by traditional method of separation during the same period. Blood loss and transfusion during operation, postoperative liver function, complication and mortality of operation, and postoperative hospital stay were compared between these two groups. RESULTS: In group A, the tumor diameters ranged (6.02 +/- 3.24) cm, the operative blood loss was (445 +/- 240) ml, and 52 patients (24.3%) underwent blood transfusion [range: (520 +/- 280) ml]. No mortality and intraabdominal hemorrhage, liver function failure, or other severe complications were noted. Only 12 patients (4.9%) suffered mild complications. The postoperative hospital stay was (13.4 +/- 4.9) days. In group B, the tumor diameters ranged (5.84 +/- 2.93 cm, the operative blood loss was (1200 +/- 320) ml, and 53 patients (34.2%) underwent transfusion [range: (1400 +/- 623) ml]. Five patients (3.23%) died within 30 days after operation. The total complication morbidity was 16.1% (25/155). Five patients suffered intraabdominal hemorrhage and 5 experienced liver function failure. Postoperative hospital stay was (18.9 +/- 10.3) days. The volume of blood loss and transfusion in group A were significantly less than in group B (P < 0.05). Mortality, severe complications, and total complication morbidity were significantly lower in group A than in group B (P < 0.05, P < 0.01). The postoperative stay was also significantly shorter in group A than in group B (P < 0.05). CONCLUSION: Anatomical method of separation is an effective method of hepatectomy with relatively low complication and mortality.