原发性肝癌外科手术过程无血切肝技术的应用

目的探讨原发性肝癌手术过程中无血切肝技术的应用及手术中失血量与预后的关系。方法回顾性统计分析1380例原发性肝癌手术切除病人的临床资料，再按照失血量分为4组，研究各组的输血量、术后并发症发生率、术后1周肝功能Child-Pugn分级、术后住院天数、术后长期存活率。结果手术过程输血量随出血量的增加而增加，各组间存在统计学差异（P〈0．01）；术后并发症的发生在出血量〉800ml时显著上升；手术后1周的肝功能（Child-Pugn评分）A级的在出血量少的前两组分别为93．7％和88．6％，而出血800～1200ml组为72．6o,4，出血〉1200ml组低至57．9％；肝功能分级组间差异非常显著（P〈0．01）；手术后住院天数随出血量增加，手术后恢复时间也增长；病人长期存活率出血量〉800ml组长期存活率显著低于出血量少组（P〈0．01）。结论无血切肝技术是控制手术过程中失血的有效方法，出血量的有效控制一定程度上预示手术后平稳恢复、长期生存。

Bleeding control in hepatectomy for primary hepatocellular carcinoma

Objective To explore the relationship between prognosis and volume of blood loss in hepatectomy for primary hepatocellular carcinoma (HCC). Methods The clinical data of 1380 patients with primary HCC treated in our hospital were retrospectively analyzed. The patients were divided into 4 groups according to the blood loss during the operatioa The volume of blood transfusion, incidence of postoperative complications, stage of Child-Pugn grading a week later, duration of hospi-talization after operation and survival rate were determined and compared among the 4 groups. Results The volume of blood transfusion was significantly increased along with the increase in blood loss (P <0. 01). More postoperative complications were found when the blood loss exceeded 800 ml. One week after the operation, the percentage of stage A of Child-Pugn grading decreased to 93.7%, 88. 6%, 72. 6% and 57. 9%, respectively, as the blood loss increased in the 4 groups. However, the percentages of stage B and C showed an increasing trend as the blood loss increased. Accordingly, the duration of hospitalization after the operation extended with the increase in blood loss. The long-term survival rate was markedly higher in the groups with a blood loss under 800ml than in those with that over 800 ml. Conclusions Non-bleeding technique is an effective method to control blood loss in hepatectomy. Less blood loss usually indicates fast recovery and long-term survival postoperatively.