摘要
目的 比较肝细胞癌解剖性肝切除(anatomic resection, AR)与非解剖性肝切除(non-anatomic resection, NAR)的临床疗效,并分析影响患者生存率的因素,为制定手术方案提供临床依据。方法 回顾性分析2014年3月1日至2017年1月31日就诊于大连医科大学附属第二医院肝胆外科行根治性肝切除术的肝细胞癌患者资料89例,其中AR组42例,NAR组47例,比较两组临床疗效。结果 AR组的平均手术时间长于NAR组,但其术中出血量及术后第3 d血清谷丙转氨酶(alanine aminotransferase, ALT)、谷草转氨酶(aspartate aminotransferase, AST)、白蛋白(albumin, ALB)明显低于NAR组(P<0.05)。在并发症方面,总并发症发生率无统计学差异(P>0.05)。AR组术后2年无瘤生存率明显高于NAR组(P<0.05)。2年总体生存率与NAR组相仿(P>0.05)。AFP(甲胎蛋白)、微血管侵犯、手术术式为影响患者的无瘤生存率的独立危险因素。甲胎蛋白(alpha-fetoprotein, AFP)和ALT为影响患者的总体生存率的独立危险因素。结论 与非解剖性肝切除术相比,解剖性肝切除技术要求复杂,手术耗时较多,但操作精细,术中出血较少,能够减少肝功能损害,提高术后早期无瘤生存率。
Objective To compare the clinical efficacy of anatomical hepatectomy (AR) and non-anatomical hepatectomy (NAR) in the treatment of primary hepatocellular carcinoma,and to analyze the affecting factors influencing the survival rate,so as to provide a clinical basis of surgical plans for hapatectomy.Method A retrospective analysis was carried out in 89 cases of hepatocellular carcinoma with radical hepatectomy in the Second Affiliated Hospital of Dalian Medical University from March 1,2014 to January 31,2017.There were 42 cases in AR Group and 47 cases in NAR group.It was compared with the clinical efficacy between the two groups.Results The study showed that average operation time in AR group was longer than that in NAR group,but the amount of intra-operative bleeding was less and alanine aminotransferase (ALT),aspartate aminotransferase(AST) and albumin(ALB)on the third day after operation were significantly lower than that of NAR group (P<0.05).In terms of complications,there was no statistical difference in the total incidence (P>0.05).The 2-year disease-free survival rate of AR group was significantly higher than that of NAR group (P<0.05).The 2-year overall survival rate was similar to that of NAR group (P>0.05).And alpha-fetoprotein (AFP),microvascular invasion,and surgical procedures were independent risk factors for the disease-free survival of patients.And AFP and alanine aminotransferase (ALT) were independent risk factors for overall survival.Conclusion Compared with non-anatomical hepatectomy,the technical requirements of anatomical hepatectomy are complex,and the operation is more time-consuming.But its more elaborate procedure and less bleeding operation can reduce liver function damage,and improve the early postoperative tumor-free survival rate.
作者
胡文豪
王洪东
沈超楹
路旭
高媛
柳勤龙
HU Wen-hao;WANG Hong-dong;SHEN Chao-ying;LU Xu;GAO Yuan;LIU Qin-long(Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Dalian Medical University,Dalian 116027,Liaoning,China)
出处
《中国现代手术学杂志》
2019年第3期172-178,共7页
Chinese Journal of Modern Operative Surgery
基金
国家自然科学基金资助项目(编号:81770617)
关键词
肝肿瘤
解剖性肝切除
非解剖性肝切除
无瘤生存
总体生存
liver neoplams
anatomical hepatectomy
non-anatomical hepatectomy
disease-free survival
overall survival
