中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
24期
1670-1673
,共4页
李绍强%梁力建%彭宝岗%殷晓煜%吕明德%匡铭%黎东明%付顺军
李紹彊%樑力建%彭寶崗%慇曉煜%呂明德%劻銘%黎東明%付順軍
리소강%량력건%팽보강%은효욱%려명덕%광명%려동명%부순군
肝细胞癌%肝切除术
肝細胞癌%肝切除術
간세포암%간절제술
Hepatocellular carcinoma%Hepatectomy
目的 研究前入路右半肝切除术与传统右半肝切除术治疗大肝癌的效果.方法 回顾性分析中山大学附属第一医院近4年来行右半肝切除术治疗的原发性肝细胞癌(HCC)188例,其中前入路右半肝切除术92例(前入路组),传统右半肝切除术96例(传统组),比较两组患者的临床病理和生存资料.结果 本组手术死亡5例(2.7%),其中前入路组2例,传统组3例.两组的临床生化指标、肿瘤病理指标(除肿瘤平均直径外)比较差异均无统计学意义.前入路组术中平均出血量、大出血(≥3000 ml)的病例数和需要输血的病例数均显著少于传统组.前入路组术后1,3年无瘤生存率分别为56.2%、30.9%,显著高于传统组的39.1%、13.0%,P=0.043.前入路组术后1,3年的累积生存率分别为75.8%、45.9%,也明显高于传统组的52.1%和9.7%,P=0.002.Cox风险比例模型显示肿瘤大小[P=0.014,危险度(OD)=1.074]和手术方式(P=0.009,OD=0.468)是影响HCC右半肝切除术后无瘤生存率的独立危险因素.手术方式(P=0.003,OD=0.369)是影响术后累积生存率的独立危险因素.结论 前入路右半肝切除术可显著减少术中出血,术后无瘤生存率和累积生存率均高于传统右半肝切除术.
目的 研究前入路右半肝切除術與傳統右半肝切除術治療大肝癌的效果.方法 迴顧性分析中山大學附屬第一醫院近4年來行右半肝切除術治療的原髮性肝細胞癌(HCC)188例,其中前入路右半肝切除術92例(前入路組),傳統右半肝切除術96例(傳統組),比較兩組患者的臨床病理和生存資料.結果 本組手術死亡5例(2.7%),其中前入路組2例,傳統組3例.兩組的臨床生化指標、腫瘤病理指標(除腫瘤平均直徑外)比較差異均無統計學意義.前入路組術中平均齣血量、大齣血(≥3000 ml)的病例數和需要輸血的病例數均顯著少于傳統組.前入路組術後1,3年無瘤生存率分彆為56.2%、30.9%,顯著高于傳統組的39.1%、13.0%,P=0.043.前入路組術後1,3年的纍積生存率分彆為75.8%、45.9%,也明顯高于傳統組的52.1%和9.7%,P=0.002.Cox風險比例模型顯示腫瘤大小[P=0.014,危險度(OD)=1.074]和手術方式(P=0.009,OD=0.468)是影響HCC右半肝切除術後無瘤生存率的獨立危險因素.手術方式(P=0.003,OD=0.369)是影響術後纍積生存率的獨立危險因素.結論 前入路右半肝切除術可顯著減少術中齣血,術後無瘤生存率和纍積生存率均高于傳統右半肝切除術.
목적 연구전입로우반간절제술여전통우반간절제술치료대간암적효과.방법 회고성분석중산대학부속제일의원근4년래행우반간절제술치료적원발성간세포암(HCC)188례,기중전입로우반간절제술92례(전입로조),전통우반간절제술96례(전통조),비교량조환자적림상병리화생존자료.결과 본조수술사망5례(2.7%),기중전입로조2례,전통조3례.량조적림상생화지표、종류병리지표(제종류평균직경외)비교차이균무통계학의의.전입로조술중평균출혈량、대출혈(≥3000 ml)적병례수화수요수혈적병례수균현저소우전통조.전입로조술후1,3년무류생존솔분별위56.2%、30.9%,현저고우전통조적39.1%、13.0%,P=0.043.전입로조술후1,3년적루적생존솔분별위75.8%、45.9%,야명현고우전통조적52.1%화9.7%,P=0.002.Cox풍험비례모형현시종류대소[P=0.014,위험도(OD)=1.074]화수술방식(P=0.009,OD=0.468)시영향HCC우반간절제술후무류생존솔적독립위험인소.수술방식(P=0.003,OD=0.369)시영향술후루적생존솔적독립위험인소.결론 전입로우반간절제술가현저감소술중출혈,술후무류생존솔화루적생존솔균고우전통우반간절제술.
Objective To compare the outcomes between anterior versus conventional approach right hepatectomy for large hepatocellutar carcinoma(HCC).Methods A total of 188 consecutive patients with large HCC(≥5 cm)undergoing right hepatectomy were reviewed retrospectively.Among them,92patients received anterior approach right hepatectomy(anterior group)while the other conventional right hepatectomy(conventional group).Their clinicopathologic data and survivals were compared.Results There were five surgical deaths(2.7%),two in the anterior group and three in the conventional group.The biochemical and tumor pathological data(except for tumor size) of these two groups were comparable.The mean intranperative blood loss,the number of patients with massive hemorrhage(＞3000ml)and the volume of blood transfusion of the anterior group were markedly less than those of conventional group.The 1-,3-year disease-free survival rates of the anterior group were significantly better than those of the conventional group anterior group were also markedly higher than those of conventional group.The Cox regression model indicated that tumor size[P=0.014,odd ratio(OD):1.074] and surgical procedure(P:0.009,OD=0.468) were independent risk factors correlated with disease-free survival.And the surgical procedure(P=0.003,OD=0.369) was the only independent risk factor for postoperative cumulative survival.Conclusion Anterior approach right hepatectomy can significantly decrease intraoperative blood loss.The postoperative survivals of large HCC patients are significantly improved by anterior approach right hepatectomy.
