CAJ | 학술논문

目的观察解剖性血流阻断法的临床效果,探讨其在大肝癌切除过程中的适用范围.方法接受手术切除的大肝癌病例212例,按血流阻断方式分为A组(解剖性血流阻断法)与P组(Pringle法),按肿瘤与肝内血管的毗邻关系,分为中央型和周围型,比较A组与P组的临床效果.结果两组病例背景资料差异无统计学意义(P＞0.05)；术中失血量[A组(632±437) ml,P组(546±549)ml]、输血病例数(A组44.33％,P组33.04％)差异无统计学意义(P＞0.05)；A组较P组术后第1天、第7天丙氨酸转氨酶(ALT)及总胆红素(TBIL)水平[ALT:A组术后第1天(384±171)U/L,第7天为(53±24) U/L；P组；第1天(446±253)U/L,第7天为66±30)U/L.TBIL:A组第1天(22.2±8.6) μmol/L,第7天为(17.6±5.1)μmol/L;P组第1天(25.7±8.1) μmol/L,第7天( 20.4±7.7) μmol/L]恢复的快(P＜0.05)；术后并发症及住院时间差异无统计学意义(P＞0.05).按部位分类后:中央型肝癌A组较P组:术中出血量(P=0.007)、输血病例数(P=0.026)减少；术后ALT及TBIL恢复快(P＜0.01)；术后并发症发生率低(P=0.031),住院时间缩短(P =0.042).周围型肝癌A组较P组:术中出血量(P=0.000),输血病例数(P=0.001)增加；术后ALT、TBIL水平及并发症发生率、住院时间差异无统计学意义(P＜0.05).结论解剖性血流阻断法适用于邻近主干血管的大肝癌切除.
목적 관찰해부성혈류조단법적림상효과,탐토기재대간암절제과정중적괄용범위.방법 접수수술절제적대간암병례212례,안혈류조단방식분위A조(해부성혈류조단법)여P조(Pringle법),안종류여간내혈관적비린관계,분위중앙형화주위형,비교A조여P조적림상효과.결과 량조병례배경자료차이무통계학의의(P＞0.05)；술중실혈량[A조(632±437) ml,P조(546±549)ml]、수혈병례수(A조44.33％,P조33.04％)차이무통계학의의(P＞0.05)；A조교P조술후제1천、제7천병안산전안매(ALT)급총담홍소(TBIL)수평[ALT:A조술후제1천(384±171)U/L,제7천위(53±24) U/L；P조；제1천(446±253)U/L,제7천위66±30)U/L.TBIL:A조제1천(22.2±8.6) μmol/L,제7천위(17.6±5.1)μmol/L;P조제1천(25.7±8.1) μmol/L,제7천( 20.4±7.7) μmol/L]회복적쾌(P＜0.05)；술후병발증급주원시간차이무통계학의의(P＞0.05).안부위분류후:중앙형간암A조교P조:술중출혈량(P=0.007)、수혈병례수(P=0.026)감소；술후ALT급TBIL회복쾌(P＜0.01)；술후병발증발생솔저(P=0.031),주원시간축단(P =0.042).주위형간암A조교P조:술중출혈량(P=0.000),수혈병례수(P=0.001)증가；술후ALT、TBIL수평급병발증발생솔、주원시간차이무통계학의의(P＜0.05).결론 해부성혈류조단법괄용우린근주간혈관적대간암절제.
Objective To retrospectively explore the clinical efficacies and applicability of anatomical vascular occlusion (AVO) in hepatectomy for grand primary hepatocarcinoma at different locations. Methods A total of 212 grand primary hepatocarcinoma cases undergoing hepatectomy were divided into 2 groups by vascular occlusion in the process of resection: AVO group (n =97) and Pringle group (Pringle maneuver,n =115).According to whether or not tumor was adjacent to main vessels,the cases were divided into 2 types: centrally ( n =98 ) and peripherally ( n =114 ) located lesions. And the perioperative outcomes were compared between 2 groups totally and by types respectively. Results No significance existed between the AVO and Pringle groups in the demographic characteristics and tumor background (P ＞0.05 ).For total cases,there were no significant differences between 2 groups regarding the intraoperative blood loss volume ( (632 ± 437 ) ml vs (546 ± 549) ml,P =0.217 ) and the blood transfusion requirement (44.3％ vs 33.0％,P =0.092 ).The AVO group showed significantly better postoperative liver functions in terms of serum levels of total bilirubin and aminotransferase ( P ＞0.05 ).But no significant difference was found between 2 groups in the postoperative complication rate ( 18.6％ vs 22.6％,P=0.469) and hospital stay duration ((10.5 ±4.8) vs (11.8 ±5.6) days,P=0.087).In centrally located lesions: the AVO group showed a significantly smaller intraoperative blood loss volume ( (722 ±492) ml vs ( 1032 ±618) ml,P =0.007) and blood transfusion requirement (45.6％ vs 68.3％,P =0.026).Also the AVO group showed significantly better postoperative liver functions in terms of serum levels of total bilirubin and aminotransferase ( P ＜ 0.01 ). As a consequence,the AVO group had a significantly lower postoperative complication rate ( 19.3％ vs 39.0％,P =0.031 ) and a shorter hospital stay duration ( ( 10.7 ±5.0) days vs ( 13.0 ±6.2) days,P =0.042).In peripheral located lesions: there were significantly larger intraoperative blood loss volume(504 ± 307 vs 278 ± 237 ml,P =0.000 ) and blood transfusion requirement (42.5％ vs 13.5％,P =0.001 ) in the AVO group. The postoperative liver functions (total bilirubin and aminotransferase levels,P ＞0.05),postoperative complication rate (17.5％vs 13.5％,P =0.808) and hospital stay duration ( ( 10.3 ±4.6) days vs ( 11.1 ±5.1 ) days,P =0.429)showed no significant differences between 2 groups.Conclusion The technique of AVO is unsuitable for all types of grand hepatocarcinoma. Whether or not the tumor is adjacent to main vessels is an important consideration of choosing the vascular control technique.Considering the risk of vascular damage in the process of hepatectomy,the AVO technique is indicated for the resection of central lesions but not for peripheral lesions.