精準(zhǔn)肝切除治療早期肝癌的療效分析
[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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