精准肝切除治疗原发性肝癌的临床疗效分析

发布时间：2018-05-27 12:29

本文选题：精准肝切除 + 原发性肝癌　；参考：《宁夏医科大学》2016年硕士论文

【摘要】：目的探讨使用精准肝切除术(Precision liver resection)治疗原发性肝癌的临床疗效。方法回顾性分析以宁夏医科大学总医院2013年1月至2015年9月收治的145例行肝切除术的原发性肝细胞癌患者作为研究对象,其中男性患者112例,女性患者33例,年龄为21-73岁,平均年龄(45.7±1.5)岁。所有患者中行常规肝切除术患者48例,精准肝切除术患者97例。常规肝切除术组男性患者35例,女性患者13例,年龄为23-69岁,平均年龄(44.1±1.9)岁。精准肝切除术组男性患者72例,女性患者25例,年龄为21-73岁,平均年龄(45.7±1.5)岁。145例患者的临床表现中,103例患者伴随有肝区疼痛症状,45例患者可明显触及右上腹部包块,17例无明显临床表现,为体检时发现。所有患者中,入院时肝功能Child-Pugh评级为A级的122例,B级的19例,但经积极干预均在术前达到A级。影像学检查:腹部B超、螺旋CT及磁共振等检查方法证实肝脏实性占位性病变,平均直径为(10.1±3.1)cm,单发肿瘤者102例,多发肿瘤者43例。记录并对比不同组别患者的手术时间及手术操作中的出血量,术后所有患者均检测并比较血清白蛋白(ALB)、谷丙转氨酶(ALT)和总胆红素(TBIL)水平。观察及对比不同组别病例的手术后并发症发生及率。对手术后病例施行1年跟随访问,观察不同组别不同病例的肿瘤复发情况和存活率异同。本次研究采用SPSS 20.0统计软件进行数据分析,对患者的术中创伤数据及术后肝功能各项指标变化采用t检验方法,而对术后患者生存率及肿瘤复发率采用方差齐性检验,且P0.05为差异存在统计学意义。结果临床指标的比较:相较于常规肝切除组,精准组患者的手术出血量、术中输血量较常规组均较少,分别为:650±130ml比1200±190ml、400±150ml比800±300ml,均P0.05,而手术时间则较常规组明显延长,分别为:2.5±0.6小时比1.4±0.6小时,P=0.011。而在术后各项肝脏功能指标比较方面,精准组术后ALT和TBIL升高水平明显较少,术后第一天分别为422.5±55.6U/L比586.6±58.2U/L,21.3umol/L比37.5±7.9umol/L,均P0.05。术后第七天分别为: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指标上,精准组较之常规组水平明显提高,术后第一天分别为:32.4±1.9g/L比21.2±3.5g/L,P=0.031。术后第七天分别为:33.5±2.1g/L比26.4±1.3g/L,P=0.029。与常规组患者相比,精准组患者的腹腔出血、胆汁溢漏、隔下感染、胸腔积液等术后并发症发生率显著降低,分别为:7.8%、5.4%、5.4%、9.8%和19.5%、16.8%、9.7%、16.8%,均P0.05。随访1年后,常规组和精准组病例的复发率及存活率无统计学差异,分别为13.2%(6/48)、77.4%(37/48)和11.1%(10/97)、84.6%(81/97)。其中所有病例术后(n=145)均完成了3月的随访,104例(72.2%)患者完成了6月的随访(5例患者失访),平均完成随访时间为5.2月。结论相比较于常规肝切除术,精准肝切除术治疗原发性肝癌疗效好,可在有效消灭病灶的同时减少并发症的发生率,有助于患者术后恢复。
[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 卤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 卤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 卤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 卤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 卤190ml 卤130ml vs 1200 卤190ml 卤150ml vs 800 卤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 卤0. 6 hours vs 1. 4 卤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 卤55.6U/L vs 586.6 卤58.2 U / L 21.3 渭 mol / L vs 37.5 卤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 卤10.3U/L to 146.3 卤21.4U / L 14.1 umol / L was 26.5 卤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 卤1.9g/L to 21.2 卤3.5 g / L was 0.031, respectively. On the seventh day after operation, the ratio of 1: 33.5 卤2.1g/L to 26.4 卤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.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7

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