精準(zhǔn)肝切除治療早期肝癌的療效分析
發(fā)布時(shí)間：2019-03-08 09:27
【摘要】：一、目的探討精準(zhǔn)肝切除對(duì)早期肝癌根治性切除的應(yīng)用價(jià)值。二、方法回顧性分析2012年7月至2014年6月南方醫(yī)院肝膽外科確診為肝細(xì)胞癌且接受根治性切除的早期肝癌174例,以BCLC-A期作為早期肝癌的納入標(biāo)準(zhǔn),將所有病例分成二組:精準(zhǔn)組和傳統(tǒng)組,其中精準(zhǔn)組118例,傳統(tǒng)組56例。精準(zhǔn)組:不阻斷任何肝臟血流或選擇性阻斷患側(cè)半肝入肝血流(部分病人一并阻斷患側(cè)出肝血流),用現(xiàn)代能量外科器械精細(xì)切肝,將切肝過(guò)程中所遇的管道一一結(jié)扎,直到目標(biāo)肝臟組織完整切除,斷肝創(chuàng)面不予縫合。傳統(tǒng)組:采用Pringle's法阻斷入肝血流,用鉗夾法切肝,肝門阻斷方式為“15+5”模式,間歇阻斷肝門直到病變完整切除,斷肝創(chuàng)面行對(duì)攏縫合。觀察指標(biāo)為:(1)基本資料:性別、年齡、基礎(chǔ)肝病、術(shù)前白蛋白、AFP、ALT、AST、Tbil水平、飲酒史、吸煙史、身高、BMI指數(shù)、乙肝病毒定量;(2)手術(shù)資料:手術(shù)時(shí)間、出血量、輸血量;(3)術(shù)后恢復(fù)情況:術(shù)后第1、3、5、7天ALT、AST、Alb、Tbil變化趨勢(shì)、術(shù)后住院時(shí)間、引流管留置時(shí)間、術(shù)后并發(fā)癥、住院經(jīng)濟(jì)費(fèi)用:(4)病理資料:腫瘤最大直徑、腫瘤組織學(xué)分化程度、肝硬化情況;(5)隨訪情況:術(shù)后復(fù)查AFP水平、影像學(xué)檢查結(jié)果、術(shù)后1、2年復(fù)發(fā)時(shí)間。三、結(jié)果兩組患者術(shù)前一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。精準(zhǔn)組與傳統(tǒng)組對(duì)比,手術(shù)出血量、輸血量、住院費(fèi)用等指標(biāo)無(wú)顯著性差異(P0.05)。精準(zhǔn)組手術(shù)時(shí)間較傳統(tǒng)組稍長(zhǎng),其差異具有統(tǒng)計(jì)學(xué)差異。傳統(tǒng)組術(shù)后并發(fā)癥發(fā)生率高于精準(zhǔn)組,傳統(tǒng)組術(shù)后共出現(xiàn)并發(fā)癥13例(其中肺部感染6例,腹腔感染3例,切口感染2例,胸腔積液2例),并發(fā)癥發(fā)生率為23.2%,精準(zhǔn)組術(shù)后共出現(xiàn)并發(fā)癥8例(其中胸腔積液4例,肺部感染2例,腹腔感染1例,切口感染1例),并發(fā)癥發(fā)生率為6.8%,兩組相比具有統(tǒng)計(jì)學(xué)差異(P0.05)。傳統(tǒng)組中位住院時(shí)間為10.5天,而精準(zhǔn)組中位住院天數(shù)為9天,其差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。傳統(tǒng)組中位引流管留置時(shí)間為7天,而精準(zhǔn)組為6天,兩組對(duì)比起差異具有統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者術(shù)后肝功能對(duì)比:第1、3、5、7天精準(zhǔn)組患者的血清AST、AST水平均明顯低于傳統(tǒng)組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);精準(zhǔn)組術(shù)后第1天白蛋白水平略低于傳統(tǒng)組,但無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后第3、5、7天白蛋白水平精準(zhǔn)組較傳統(tǒng)組恢復(fù)更快,其差異具有統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后第1、3、5天總膽紅素水平精準(zhǔn)組血清總膽紅素水平均較傳統(tǒng)組低,其差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪:術(shù)后1、2年無(wú)瘤生存率精準(zhǔn)組為 79.7%(94/118)、60.9%(46/118),傳統(tǒng)組為 50%(28/56)、46.4%(26/56),兩組比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=4.741,8.722,P0.05)。四、結(jié)論對(duì)早期肝癌患者采用精準(zhǔn)肝切除術(shù),其術(shù)后肝功能恢復(fù)更快,并最大限度地減少并發(fā)癥的發(fā)生率,其住院時(shí)間及引流管留置時(shí)間更短,具有更好的近期療效,是值得推薦的肝切除方法。
[Abstract]:1. Objective to evaluate the clinical value of accurate hepatectomy in radical resection of early hepatocellular carcinoma (HCC). 2. Methods from July 2012 to June 2014, we retrospectively analyzed 174 cases of early hepatocellular carcinoma diagnosed by hepatobiliary surgery in Southern Hospital and received radical resection. BCLC-A stage was used as the inclusion standard of early liver cancer. All cases were divided into two groups: precision group (n = 118) and traditional group (n = 56). Precision group: do not block any hepatic blood flow or selectively block the blood flow from the affected side of the liver (some patients also block the affected side of the hepatic blood flow), with modern energy surgical instruments fine resection of the liver, one by one ligation of the pipes encountered in the hepatectomy process. The cut liver wound was not sutured until the target liver tissue was completely resected. In the traditional group, the hepatic blood flow was blocked by Pringle' s method, the liver was cut by clamp method, the hepatic hilum was blocked in "155" mode, the hepatic portal was blocked intermittently until the lesion was completely resected, and the liver was cut together and sutured on the cut side of the liver. The observation indexes were as follows: (1) basic data: sex, age, basic liver disease, preoperative albumin, AFP,ALT,AST,Tbil level, drinking history, smoking history, height, BMI index, hepatitis B virus quantitative; (2) operative data: operation time, volume of bleeding, volume of blood transfusion; (3) postoperative recovery: trend of ALT,AST,Alb,Tbil change at 1,3,5,7 days after operation, length of hospital stay, drainage tube indwelling time, postoperative complications, cost of hospitalization: (4) pathological data: maximum diameter of tumor, length of stay of drainage tube after operation, postoperative complications, cost of hospitalization: (4) pathological data: maximum diameter of tumor. Degree of histological differentiation, liver cirrhosis; (5) follow-up: the level of AFP was reexamined after operation, the result of imaging examination and the recurrence time of 1 and 2 years after operation. Results there was no significant difference in preoperative general data between the two groups (P0.05), and there was comparability between the two groups. There was no significant difference in operative bleeding volume, transfusion volume and hospitalization cost between the precise group and the traditional group (P0.05). The operation time in the precision group was slightly longer than that in the traditional group, and the difference was statistically significant. The incidence of postoperative complications in the traditional group was higher than that in the precision group. In the traditional group, complications occurred in 13 cases (pulmonary infection in 6 cases, abdominal infection in 3 cases, incision infection in 2 cases, pleural effusion in 2 cases), and the incidence of complications was 23.2%. In the precision group, complications occurred in 8 cases (4 cases of pleural effusion, 2 cases of pulmonary infection, 1 case of abdominal infection and 1 case of incision infection). The incidence of complications was 6.8%. There was significant difference between the two groups (P0.05). The median hospitalization time was 10.5 days in the traditional group and 9 days in the precision group, the difference was statistically significant (P0.05). The median drainage tube indwelling time was 7 days in the traditional group and 6 days in the precision group. There was significant difference between the two groups (P0.05). The levels of serum AST,AST in the precision group were significantly lower than those in the traditional group on the 1st, 3rd, 5th and 7th day after operation, and the difference was statistically significant (P0.05). The level of albumin in the precision group on the first day after operation was slightly lower than that in the traditional group, but there was no statistical significance (P0.05). The albumin level in the precision group recovered faster than that in the traditional group on the 3rd, 5th and 7th day after operation, and the difference was statistically significant (P0.05). The level of serum total bilirubin in the precision group was lower than that in the traditional group on the 1st, 3rd and 5th day after operation, and the difference was statistically significant (P0.05). Follow-up: the 2-year disease-free survival rate was 79.7% (94 / 118), 60.9% (46 / 118) in the accurate group, 50% (28 / 56) and 46.4% (26 / 56) in the traditional group, respectively. The difference was statistically significant (蠂 2 = 4.741, 8.722, P0.05). 4. Conclusion precise hepatectomy was used in the early stage of liver cancer, the liver function recovered faster and the incidence of complications was minimized, the hospitalization time and drainage tube indwelling time were shorter, and the short-term curative effect was better, and the liver function recovered more quickly after operation, and the incidence of complications was minimized. It is a recommended method of hepatectomy.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
本文編號(hào)：2436671
[Abstract]:1. Objective to evaluate the clinical value of accurate hepatectomy in radical resection of early hepatocellular carcinoma (HCC). 2. Methods from July 2012 to June 2014, we retrospectively analyzed 174 cases of early hepatocellular carcinoma diagnosed by hepatobiliary surgery in Southern Hospital and received radical resection. BCLC-A stage was used as the inclusion standard of early liver cancer. All cases were divided into two groups: precision group (n = 118) and traditional group (n = 56). Precision group: do not block any hepatic blood flow or selectively block the blood flow from the affected side of the liver (some patients also block the affected side of the hepatic blood flow), with modern energy surgical instruments fine resection of the liver, one by one ligation of the pipes encountered in the hepatectomy process. The cut liver wound was not sutured until the target liver tissue was completely resected. In the traditional group, the hepatic blood flow was blocked by Pringle' s method, the liver was cut by clamp method, the hepatic hilum was blocked in "155" mode, the hepatic portal was blocked intermittently until the lesion was completely resected, and the liver was cut together and sutured on the cut side of the liver. The observation indexes were as follows: (1) basic data: sex, age, basic liver disease, preoperative albumin, AFP,ALT,AST,Tbil level, drinking history, smoking history, height, BMI index, hepatitis B virus quantitative; (2) operative data: operation time, volume of bleeding, volume of blood transfusion; (3) postoperative recovery: trend of ALT,AST,Alb,Tbil change at 1,3,5,7 days after operation, length of hospital stay, drainage tube indwelling time, postoperative complications, cost of hospitalization: (4) pathological data: maximum diameter of tumor, length of stay of drainage tube after operation, postoperative complications, cost of hospitalization: (4) pathological data: maximum diameter of tumor. Degree of histological differentiation, liver cirrhosis; (5) follow-up: the level of AFP was reexamined after operation, the result of imaging examination and the recurrence time of 1 and 2 years after operation. Results there was no significant difference in preoperative general data between the two groups (P0.05), and there was comparability between the two groups. There was no significant difference in operative bleeding volume, transfusion volume and hospitalization cost between the precise group and the traditional group (P0.05). The operation time in the precision group was slightly longer than that in the traditional group, and the difference was statistically significant. The incidence of postoperative complications in the traditional group was higher than that in the precision group. In the traditional group, complications occurred in 13 cases (pulmonary infection in 6 cases, abdominal infection in 3 cases, incision infection in 2 cases, pleural effusion in 2 cases), and the incidence of complications was 23.2%. In the precision group, complications occurred in 8 cases (4 cases of pleural effusion, 2 cases of pulmonary infection, 1 case of abdominal infection and 1 case of incision infection). The incidence of complications was 6.8%. There was significant difference between the two groups (P0.05). The median hospitalization time was 10.5 days in the traditional group and 9 days in the precision group, the difference was statistically significant (P0.05). The median drainage tube indwelling time was 7 days in the traditional group and 6 days in the precision group. There was significant difference between the two groups (P0.05). The levels of serum AST,AST in the precision group were significantly lower than those in the traditional group on the 1st, 3rd, 5th and 7th day after operation, and the difference was statistically significant (P0.05). The level of albumin in the precision group on the first day after operation was slightly lower than that in the traditional group, but there was no statistical significance (P0.05). The albumin level in the precision group recovered faster than that in the traditional group on the 3rd, 5th and 7th day after operation, and the difference was statistically significant (P0.05). The level of serum total bilirubin in the precision group was lower than that in the traditional group on the 1st, 3rd and 5th day after operation, and the difference was statistically significant (P0.05). Follow-up: the 2-year disease-free survival rate was 79.7% (94 / 118), 60.9% (46 / 118) in the accurate group, 50% (28 / 56) and 46.4% (26 / 56) in the traditional group, respectively. The difference was statistically significant (蠂 2 = 4.741, 8.722, P0.05). 4. Conclusion precise hepatectomy was used in the early stage of liver cancer, the liver function recovered faster and the incidence of complications was minimized, the hospitalization time and drainage tube indwelling time were shorter, and the short-term curative effect was better, and the liver function recovered more quickly after operation, and the incidence of complications was minimized. It is a recommended method of hepatectomy.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
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