CAJ | 학술논문

目的：探讨解剖性肝切除和非解剖性肝切除对肝细胞癌患者预后的影响。方法62例肝细胞癌患者，其中33例采用解剖性肝切除术进行治疗（AH组），29例采用非解剖性肝切除术进行治疗（IH组）；记录手术情况和血红蛋白（Hb）损失量。术后采取患者空腹静脉血，检测肝细胞癌AFP mRNA表达；并记录复发率、死亡率及并发症情况。结果 AH组的平均手术时间显著高于IH组，但术中出血量和手术Hb损失量显著低于IH组（P＜0．05）；两组患者的AFP mRNA表达水平和术后复发率差异无统计学意义（P ＞0．05），AH组的近期死亡率稍低于IH组（P＜0．05），但远期死亡率与IH组相仿（P ＞0．05）；在并发症方面，总发生率差异无统计学意义（P ＞0．05），但AH组以肝功能障碍为主，多发于肝硬化或肝纤维化患者，IH组以腹腔内出血和感染为主，多发生于中心性肿瘤患者。结论解剖性切除术能够有效保护肝细胞癌血管，可改善患者预后，但对于肝脏存在严重病理性损伤患者，存在一定风险，可考虑非解剖性切除术。
목적：탐토해부성간절제화비해부성간절제대간세포암환자예후적영향。방법62례간세포암환자，기중33례채용해부성간절제술진행치료（AH조），29례채용비해부성간절제술진행치료（IH조）；기록수술정황화혈홍단백（Hb）손실량。술후채취환자공복정맥혈，검측간세포암AFP mRNA표체；병기록복발솔、사망솔급병발증정황。결과 AH조적평균수술시간현저고우IH조，단술중출혈량화수술Hb손실량현저저우IH조（P＜0．05）；량조환자적AFP mRNA표체수평화술후복발솔차이무통계학의의（P ＞0．05），AH조적근기사망솔초저우IH조（P＜0．05），단원기사망솔여IH조상방（P ＞0．05）；재병발증방면，총발생솔차이무통계학의의（P ＞0．05），단AH조이간공능장애위주，다발우간경화혹간섬유화환자，IH조이복강내출혈화감염위주，다발생우중심성종류환자。결론해부성절제술능구유효보호간세포암혈관，가개선환자예후，단대우간장존재엄중병이성손상환자，존재일정풍험，가고필비해부성절제술。
Objective To explore the effects of anatomical and nonanatomical hepatectomy on the prognosis of patients with hepatocellular carcinoma(HCC).Methods A total of 62 HCC patients were enrolled,including 33 cases of anatomical hepatectomy(Group AH)and 29 cases of nonanatomical hepa-tectomy(Group IH).The operation situation and hematocrystallin(HB)loss were record.Fasting venous blood of HCC patients were extracted for detection of circulating AFP mRNA expression.The recurrence, mortality and complication rate were recorded at the same time.Results The operative time of Group AH was significantly higher than that of Group IH,while the bleeding volume and HB loss were lower(P<0.05).There were no significant differences in AFP mRNA expression and recurrence rate.The short-term mortality rate of Group AH was lower than Group IH(P<0.05 ),but their long-term mortality rates were similar(P>0.05 ).There was no significant difference in complication rate between groups.Patients of Group AH got more hepatosis due to liver cirrhosis or fibrosis,while patients of Group IH got more bleeding or infection due to the central tumor.Conclusion Anatomical hepatectomy has advantages in protecting artery and improving prognosis for HCC patients,but it has surgical risks for patients with serious patholog-ical damage in hepatic lobes,and nonanatomical hepatectomy may be considered.