精准肝切除治疗早期肝癌的疗效分析
发布时间：2019-03-08 09:27
【摘要】：一、目的探讨精准肝切除对早期肝癌根治性切除的应用价值。二、方法回顾性分析2012年7月至2014年6月南方医院肝胆外科确诊为肝细胞癌且接受根治性切除的早期肝癌174例,以BCLC-A期作为早期肝癌的纳入标准,将所有病例分成二组:精准组和传统组,其中精准组118例,传统组56例。精准组:不阻断任何肝脏血流或选择性阻断患侧半肝入肝血流(部分病人一并阻断患侧出肝血流),用现代能量外科器械精细切肝,将切肝过程中所遇的管道一一结扎,直到目标肝脏组织完整切除,断肝创面不予缝合。传统组:采用Pringle's法阻断入肝血流,用钳夹法切肝,肝门阻断方式为“15+5”模式,间歇阻断肝门直到病变完整切除,断肝创面行对拢缝合。观察指标为:(1)基本资料:性别、年龄、基础肝病、术前白蛋白、AFP、ALT、AST、Tbil水平、饮酒史、吸烟史、身高、BMI指数、乙肝病毒定量;(2)手术资料:手术时间、出血量、输血量;(3)术后恢复情况:术后第1、3、5、7天ALT、AST、Alb、Tbil变化趋势、术后住院时间、引流管留置时间、术后并发症、住院经济费用:(4)病理资料:肿瘤最大直径、肿瘤组织学分化程度、肝硬化情况;(5)随访情况:术后复查AFP水平、影像学检查结果、术后1、2年复发时间。三、结果两组患者术前一般资料比较,差异无统计学意义(P0.05),具有可比性。精准组与传统组对比,手术出血量、输血量、住院费用等指标无显著性差异(P0.05)。精准组手术时间较传统组稍长,其差异具有统计学差异。传统组术后并发症发生率高于精准组,传统组术后共出现并发症13例(其中肺部感染6例,腹腔感染3例,切口感染2例,胸腔积液2例),并发症发生率为23.2%,精准组术后共出现并发症8例(其中胸腔积液4例,肺部感染2例,腹腔感染1例,切口感染1例),并发症发生率为6.8%,两组相比具有统计学差异(P0.05)。传统组中位住院时间为10.5天,而精准组中位住院天数为9天,其差异具有统计学意义(P0.05)。传统组中位引流管留置时间为7天,而精准组为6天,两组对比起差异具有统计学差异(P0.05)。两组患者术后肝功能对比:第1、3、5、7天精准组患者的血清AST、AST水平均明显低于传统组,差异具有统计学意义(P0.05);精准组术后第1天白蛋白水平略低于传统组,但无统计学意义(P0.05),术后第3、5、7天白蛋白水平精准组较传统组恢复更快,其差异具有统计学差异(P0.05);术后第1、3、5天总胆红素水平精准组血清总胆红素水平均较传统组低,其差异具有统计学意义(P0.05)。随访:术后1、2年无瘤生存率精准组为 79.7%(94/118)、60.9%(46/118),传统组为 50%(28/56)、46.4%(26/56),两组比较,差异有统计学意义(χ2=4.741,8.722,P0.05)。四、结论对早期肝癌患者采用精准肝切除术,其术后肝功能恢复更快,并最大限度地减少并发症的发生率,其住院时间及引流管留置时间更短,具有更好的近期疗效,是值得推荐的肝切除方法。
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
本文编号：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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
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