本文選題：精準(zhǔn)肝切除 + 原發(fā)性肝癌��； 參考：《寧夏醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的探討使用精準(zhǔn)肝切除術(shù)(Precision liver resection)治療原發(fā)性肝癌的臨床療效。方法回顧性分析以寧夏醫(yī)科大學(xué)總醫(yī)院2013年1月至2015年9月收治的145例行肝切除術(shù)的原發(fā)性肝細(xì)胞癌患者作為研究對(duì)象,其中男性患者112例,女性患者33例,年齡為21-73歲,平均年齡(45.7±1.5)歲。所有患者中行常規(guī)肝切除術(shù)患者48例,精準(zhǔn)肝切除術(shù)患者97例。常規(guī)肝切除術(shù)組男性患者35例,女性患者13例,年齡為23-69歲,平均年齡(44.1±1.9)歲。精準(zhǔn)肝切除術(shù)組男性患者72例,女性患者25例,年齡為21-73歲,平均年齡(45.7±1.5)歲。145例患者的臨床表現(xiàn)中,103例患者伴隨有肝區(qū)疼痛癥狀,45例患者可明顯觸及右上腹部包塊,17例無(wú)明顯臨床表現(xiàn),為體檢時(shí)發(fā)現(xiàn)。所有患者中,入院時(shí)肝功能Child-Pugh評(píng)級(jí)為A級(jí)的122例,B級(jí)的19例,但經(jīng)積極干預(yù)均在術(shù)前達(dá)到A級(jí)。影像學(xué)檢查:腹部B超、螺旋CT及磁共振等檢查方法證實(shí)肝臟實(shí)性占位性病變,平均直徑為(10.1±3.1)cm,單發(fā)腫瘤者102例,多發(fā)腫瘤者43例。記錄并對(duì)比不同組別患者的手術(shù)時(shí)間及手術(shù)操作中的出血量,術(shù)后所有患者均檢測(cè)并比較血清白蛋白(ALB)、谷丙轉(zhuǎn)氨酶(ALT)和總膽紅素(TBIL)水平。觀察及對(duì)比不同組別病例的手術(shù)后并發(fā)癥發(fā)生及率。對(duì)手術(shù)后病例施行1年跟隨訪問(wèn),觀察不同組別不同病例的腫瘤復(fù)發(fā)情況和存活率異同。本次研究采用SPSS 20.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,對(duì)患者的術(shù)中創(chuàng)傷數(shù)據(jù)及術(shù)后肝功能各項(xiàng)指標(biāo)變化采用t檢驗(yàn)方法,而對(duì)術(shù)后患者生存率及腫瘤復(fù)發(fā)率采用方差齊性檢驗(yàn),且P0.05為差異存在統(tǒng)計(jì)學(xué)意義。結(jié)果臨床指標(biāo)的比較:相較于常規(guī)肝切除組,精準(zhǔn)組患者的手術(shù)出血量、術(shù)中輸血量較常規(guī)組均較少,分別為:650±130ml比1200±190ml、400±150ml比800±300ml,均P0.05,而手術(shù)時(shí)間則較常規(guī)組明顯延長(zhǎng),分別為:2.5±0.6小時(shí)比1.4±0.6小時(shí),P=0.011。而在術(shù)后各項(xiàng)肝臟功能指標(biāo)比較方面,精準(zhǔn)組術(shù)后ALT和TBIL升高水平明顯較少,術(shù)后第一天分別為422.5±55.6U/L比586.6±58.2U/L,21.3umol/L比37.5±7.9umol/L,均P0.05。術(shù)后第七天分別為:97.6±10.3U/L比146.3±21.4U/L,14.1umol/L比26.5±4.8umol/L,均P0.05。而在ALB指標(biāo)上,精準(zhǔn)組較之常規(guī)組水平明顯提高,術(shù)后第一天分別為:32.4±1.9g/L比21.2±3.5g/L,P=0.031。術(shù)后第七天分別為:33.5±2.1g/L比26.4±1.3g/L,P=0.029。與常規(guī)組患者相比,精準(zhǔn)組患者的腹腔出血、膽汁溢漏、隔下感染、胸腔積液等術(shù)后并發(fā)癥發(fā)生率顯著降低,分別為:7.8%、5.4%、5.4%、9.8%和19.5%、16.8%、9.7%、16.8%,均P0.05。隨訪1年后,常規(guī)組和精準(zhǔn)組病例的復(fù)發(fā)率及存活率無(wú)統(tǒng)計(jì)學(xué)差異,分別為13.2%(6/48)、77.4%(37/48)和11.1%(10/97)、84.6%(81/97)。其中所有病例術(shù)后(n=145)均完成了3月的隨訪,104例(72.2%)患者完成了6月的隨訪(5例患者失訪),平均完成隨訪時(shí)間為5.2月。結(jié)論相比較于常規(guī)肝切除術(shù),精準(zhǔn)肝切除術(shù)治療原發(fā)性肝癌療效好,可在有效消滅病灶的同時(shí)減少并發(fā)癥的發(fā)生率,有助于患者術(shù)后恢復(fù)。
[Abstract]:Objective to investigate the clinical effect of precision liver resection in the treatment of primary liver cancer. Methods A retrospective study was conducted on 145 patients with primary hepatocellular carcinoma (HCC) who underwent hepatectomy in Ningxia Medical University General Hospital from January 2013 to September 2015. 112 cases were male and 33 cases were female, aged 21-73 years. The average age was 45.7 鹵1.5 years old. Among all the patients, 48 patients underwent routine hepatectomy and 97 patients underwent accurate hepatectomy. In routine hepatectomy group, there were 35 male patients and 13 female patients aged from 23 to 69 years, with an average age of 44.1 鹵1.9 years. In the precision hepatectomy group, there were 72 male and 25 female patients aged 21-73 years. The mean age was 45.7 鹵1.5 years. The clinical manifestations of 103 patients with pain in the liver region were found in 17 patients with right epigastric mass. In all the patients, the Child-Pugh of liver function at admission was grade A (n = 19) and grade B (n = 19), but after active intervention, it reached grade A before operation. Imaging examination: abdominal B-ultrasonography, spiral CT and magnetic resonance imaging were used to confirm the solid occupying lesions of liver, the average diameter was 10.1 鹵3.1 cm, 102 cases had single tumor and 43 cases had multiple tumors. The time of operation and the amount of blood loss during operation were recorded and compared in different groups of patients. The levels of serum albumin, alanine aminotransferase (alt) and total bilirubin (TBIL) were detected and compared in all patients after operation. The incidence and rate of postoperative complications in different groups of cases were observed and compared. One year follow-up visit was performed to observe the recurrence and survival rate of different groups of patients. In this study, SPSS 20.0 statistical software was used to analyze the data. T test was used to analyze the intraoperative trauma data and the changes of liver function indexes after operation, while the survival rate and recurrence rate of the patients were examined by variance homogeneity test. And P0.05 for the difference was statistically significant. Results compared with the routine hepatectomy group, the volume of operative blood loss and blood transfusion in the accurate group were less than those in the routine group, which were 1200 鹵190ml 鹵130ml vs 1200 鹵190ml 鹵150ml vs 800 鹵300ml, respectively (P 0.05), and the operative time was significantly longer than that in the conventional group. The results were as follows: 1. 5 鹵0. 6 hours vs 1. 4 鹵0. 6 hours, respectively. In the comparison of liver function indexes, the elevation of ALT and TBIL in the accurate group was significantly lower than that in the control group (422.5 鹵55.6U/L vs 586.6 鹵58.2 U / L 21.3 渭 mol / L vs 37.5 鹵7.9 umol / L, P 0.05, respectively) on the first day after operation. On the seventh day after operation, the ratio of: 97.6 鹵10.3U/L to 146.3 鹵21.4U / L 14.1 umol / L was 26.5 鹵4.8umol / L, respectively (P 0.05). However, the level of ALB in the precision group was significantly higher than that in the conventional group, and on the first day after operation, the ratio of 1: 32.4 鹵1.9g/L to 21.2 鹵3.5 g / L was 0.031, respectively. On the seventh day after operation, the ratio of 1: 33.5 鹵2.1g/L to 26.4 鹵1.3 g / L was 0.029. Compared with the conventional group, the incidence of postoperative complications such as intraperitoneal hemorrhage, bile leakage, subseptal infection and pleural effusion in the precision group was significantly lower than that in the conventional group (P < 0.05). The incidence of postoperative complications was significantly lower in the precision group than in the conventional group. The incidence of postoperative complications was significantly lower in the precision group than in the control group (P < 0.05). After one year of follow-up, there was no significant difference in the recurrence rate and survival rate between the conventional group and the accurate group, which were 13. 2 / 48 / 77.437 / 48) and 11. 1 / 97 / 97 / 84.66 / 97 respectively. All the patients were followed up for 3 months, 104 patients were followed up for 6 months, 5 patients lost their visit, and the average follow-up time was 5.2 months. Conclusion compared with conventional hepatectomy, accurate hepatectomy is more effective than conventional hepatectomy in the treatment of primary liver cancer. It can effectively eliminate the focus and reduce the incidence of complications.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.7

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