引用本文:庞飞雄,赖彦华,黄晓春,曾 博,何 辉,张嘉越.精准肝脏外科理念下解剖性肝切除治疗肝细胞癌的临床疗效分析[J].中国临床新医学,2020,13(5):474-478.
【打印本页】   【下载PDF全文】   查看/发表评论  【EndNote】   【RefMan】   【BibTex】
←前一篇|后一篇→ 过刊浏览    高级检索
本文已被:浏览 90次   下载 130 本文二维码信息
码上扫一扫!
分享到: 微信 更多
精准肝脏外科理念下解剖性肝切除治疗肝细胞癌的临床疗效分析
庞飞雄,赖彦华,黄晓春,曾 博,何 辉,张嘉越
530021 南宁,广西壮族自治区人民医院移植科(庞飞雄,赖彦华,黄晓春);530021 广西,中国人民解放军联勤保障部队第九二三医院普通外科(曾 博,何 辉,张嘉越)
摘要:
[摘要] 目的 分析精准肝脏外科理念下解剖性肝切除治疗肝细胞癌的临床疗效。方法 回顾性分析2012-05~2017-05在中国人民解放军联勤保障部队第九二三医院住院并行解剖性肝切除术治疗的肝细胞癌患者206例。遵循精准肝脏外科理念,所有患者完善术前检查和精确评估肝脏储备功能,通过影像精准评价病灶的解剖学特点,精密规划解剖性肝切除方案,精细操作完成相应肝亚段、肝段、肝叶等解剖性肝切除术,观察手术相关指标,随访评价疗效。术后电话随访、门诊复查,随访时间截至2019-05-31。结果 177例行开放性肝切除术,29例行腹腔镜肝切除术。其中32例术中行Pringle法肝门入肝血流阻断术,81例行半肝入肝血流阻断术,63例行选择性肝叶或肝段入肝血流阻断术,30例行入肝血流不阻断术。手术时间为45~300(173.8±65.2)min。术中出血量为50~1 000(207.9±142.1)ml。术中输血10例,其中输红细胞3例,输血率为4.9%,平均输血量为235 ml。术后住院时间为(11.3±2.3)d。术后2例出现肝功能不全,经内科治疗肝功能恢复后顺利出院,无围手术期死亡病例。206例患者均获得随访,随访时间为24~84个月,术后1年、3年和5年存活率分别为85.4%、57.4%和39.2%;术后1年、3年和5年无瘤存活率分别为75.2%、43.8%和24.3%。结论 解剖性肝切除手术安全可靠,术后近期及远期生存疗效肯定。解剖性肝切除可作为肝细胞癌常规手术治疗的首选方案。
关键词:  解剖性肝切除  肝细胞癌  存活率
DOI:10.3969/j.issn.1674-3806.2020.05.11
分类号:R 735.7
基金项目:广西科技计划项目(编号:2018AD09004)
Clinical analysis of anatomical liver resection in treatment of hepatocellular carcinoma under the concept of precise liver surgery
PANG Fei-xiong, LAI Yan-hua, HUANG Xiao-chun, et al.
Department of Organ Transplantation, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Objective To analyze the clinical efficacy of anatomical liver resection(AR) in treatment of hepatocellular carcinoma under the concept of precise liver surgery. Methods A retrospective study was performed on 206 hepatocellular carcinoma patients who were admitted to the No.923 hospital of people′s liberation army from May 2012 to May 2017 and their clinical data were retrospective analyzed. According to the concept of precise liver surgery, all the patients received careful and complete examination and accurate evaluation of liver reserve function before surgery, and the precise planning of the anatomical hepatectomy scheme, precise operation to complete the corresponding liver sub-segments, liver segments, liver lobes and other AR were conducted through accurate imaging evaluation of the anatomical characteristics of the foci. The operation related indicators were observed and the follow-up was done to evaluate the curative effects. The patients were followed up by telephone after operation and outpatient reexaminations were conducted on them. The follow-up time was up to May 31, 2019. Results One hundred and seventy-seven cases underwent open hepatectomy and 29 cases underwent laparoscopic hepatectomy. Among the 177 patients, 32 cases were blocked hepatic portal blood flow by Pringle method; 81 cases were blocked by hemi-hepatic blood flow method; 63 cases were blocked hepatic blood flow by selective hepatic lobe or hepatic segment method and the other 30 cases were not blocked hepatic blood flow. The operation time was 45~300(173.8±65.2)min. The amount of intraoperative bleeding was 50~1 000(207.9±142.1)ml. 10 cases received intraoperative blood transfusion among whom 3 cases received intraoperative blood transfusion of red blood cells. The transfusion rate was 4.9% and the average transfusion volume was 235 ml. The postoperative hospital stay was (11.3±2.3)days. After operation, 2 cases were found with liver dysfunction, which was discharged smoothly after medical treatment. There were no perioperative deaths. All the 206 patients were followed up for 24 to 84 months. The 1-, 3-, 5-year survival rates were 85.4%, 57.4% and 39.2% respectively. The 1-, 3-, 5-year tumor-free survival rates were 75.2%, 43.8% and 24.3% respectively. Conclusion AR is safe and reliable. The short-term and long-term survival effects after surgery are satisfactory. AR can be the first choice for routine surgical treatment of hepatocellular carcinoma.
Key words:  Anatomical liver resection(AR)  Hepatocellular carcinoma  Survival rate