选择性出入肝血流阻断在巨大肝癌肝切除术中的应用
선택성출입간혈류조단재거대간암간절제술중적응용
Effects of selective hepatic vascular occlusion on the prognosis of patients undergoing hepatic resection for huge liver cancer
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    CHINESE JOURNAL OF DIGESTIVE SURGERY
    2012年 6期 514-517 ,共4页

    吴伟顶%胡智明%赵大建%张成武%张宇华%刘杰%叶再元

    오위정%호지명%조대건%장성무%장우화%류걸%협재원

    肝肿瘤%肝切除术%肝血流阻断%复发 肝腫瘤%肝切除術%肝血流阻斷%複髮
    간종류%간절제술%간혈류조단%복발
    Liver neoplasms%Hepatectomy%Hepatic vascular occlusion%Recurrence
    目的 探讨行巨大肝癌肝切除术时选择性出入肝血流阻断技术对患者预后的影响.方法 回顾性分析2005年1月至2010年1月浙江省人民医院收治的49例巨大肝癌行肝切除术患者的临床资料.根据肝脏血流阻断技术不同,分为第一肝门血流阻断组(第一肝门组,24例)和选择性出入肝血流阻断组(选择阻断组,25例).分析两组患者手术情况、肝肾功能、并发症、生存率和肝癌复发情况.计量资料采用t检验,计数资料比较采用x2检验或Fisher确切概率法,采用Kaplan-Meier法绘制生存曲线,生存情况比较采用Log-rank检验.结果 两组患者均顺利施行肝切除术,第一肝门组患者的肝血流阻断时间为(32±19) min,选择阻断组为(34±22) min,两组比较,差异无统计学意义(t=2.45,P＞0.05).第一肝门组患者的术中出血量为(736±543) ml,明显多于选择阻断组(273 ±298)ml(t =6.87,P＜0.05).第一肝门组患者肝静脉损伤的发生率为21％(5/24),选择阻断组为24％(6/25),两组比较,差异无统计学意义(x2=1.45,P＞0.05).第一肝门组有3例患者出现肝静脉破裂大出血,1例患者发生空气栓塞抢救无效死亡；选择阻断组未发生上述情况.第一肝门组患者中4例发现肿瘤侵犯血管,选择阻断组患者中3例发现肿瘤侵犯血管,两组患者切缘均为阴性.两组术前肝功能无明显差别,选择阻断组术后第1、3天ALT值较第一肝门组明显降低(t=7.12,6.35,P＜0.05)；两组尿素氮、肌酐比较,差异无统计学意义(P＞0.05).第一肝门组术后发生急性肝功能衰竭4例,选择阻断组无一例发生术后急性肝功能衰竭.第一肝门组1、3年无瘤生存率分别为58％、21％,明显低于选择阻断组的72％、30％(x2=5.32,6.07,P＜0.05).第一肝门组5年无瘤生存率为21％,选择阻断组为20％,两组比较,差异无统计学意义(x2=1.78,P＞0.05).结论 选择性出入肝血流阻断肝切除术是一种安全、简便的方法,能有效预防肝静脉破裂出血和术后急性肝功能衰竭,并有助于减少巨大肝癌肝切除术后早期肿瘤复发,提高术后早期无瘤生存率.
    목적 탐토행거대간암간절제술시선택성출입간혈류조단기술대환자예후적영향.방법 회고성분석2005년1월지2010년1월절강성인민의원수치적49례거대간암행간절제술환자적림상자료.근거간장혈류조단기술불동,분위제일간문혈류조단조(제일간문조,24례)화선택성출입간혈류조단조(선택조단조,25례).분석량조환자수술정황、간신공능、병발증、생존솔화간암복발정황.계량자료채용t검험,계수자료비교채용x2검험혹Fisher학절개솔법,채용Kaplan-Meier법회제생존곡선,생존정황비교채용Log-rank검험.결과 량조환자균순리시행간절제술,제일간문조환자적간혈류조단시간위(32±19) min,선택조단조위(34±22) min,량조비교,차이무통계학의의(t=2.45,P＞0.05).제일간문조환자적술중출혈량위(736±543) ml,명현다우선택조단조(273 ±298)ml(t =6.87,P＜0.05).제일간문조환자간정맥손상적발생솔위21％(5/24),선택조단조위24％(6/25),량조비교,차이무통계학의의(x2=1.45,P＞0.05).제일간문조유3례환자출현간정맥파렬대출혈,1례환자발생공기전새창구무효사망；선택조단조미발생상술정황.제일간문조환자중4례발현종류침범혈관,선택조단조환자중3례발현종류침범혈관,량조환자절연균위음성.량조술전간공능무명현차별,선택조단조술후제1、3천ALT치교제일간문조명현강저(t=7.12,6.35,P＜0.05)；량조뇨소담、기항비교,차이무통계학의의(P＞0.05).제일간문조술후발생급성간공능쇠갈4례,선택조단조무일례발생술후급성간공능쇠갈.제일간문조1、3년무류생존솔분별위58％、21％,명현저우선택조단조적72％、30％(x2=5.32,6.07,P＜0.05).제일간문조5년무류생존솔위21％,선택조단조위20％,량조비교,차이무통계학의의(x2=1.78,P＞0.05).결론 선택성출입간혈류조단간절제술시일충안전、간편적방법,능유효예방간정맥파렬출혈화술후급성간공능쇠갈,병유조우감소거대간암간절제술후조기종류복발,제고술후조기무류생존솔.
    Objective To evaluate the effects of selective hepatic vascular occlusion SHVO) on the prognosis of patients undergoing hepatic resection for huge liver cancer.Methods The clinical data of 49 patients who received huge liver cancer resection at the Zhejiang People's Hospital from January 2005 to January 2010 were retrospectively analyzed.Based on the type of hepatic vascular occlusion,all patients were divided into Pringle's maneuver group (24 patients) and SHVO group (25 patients).The intraoperative condition,postoperative recovery of hepatic and renal function,incidence of complications,survival rate and recurrence rate of liver cancer of the 2 groups were compared.All data were analyzed by using the t test or Fisher exact probability.The survival curve was drawn by using the Kaplan-Meier method and the survival of the 2 groups was compared by using the Log-rank test.Results Hepatectomy was successfully performed on all the patients.Time for blood occlusion were (32 ±19) minutes in the Pringle's maneuver group and (34 ± 22)minutes in the SHVO group,with no significant difference between the 2 groups (t =2.45,P ＞ 0.05).The volume of blood loss of the Pringle's maneuver group was (736 ± 543) ml,which was significantly greater than (273 ± 298) ml of the SHVO group (t =6.87,P ＜0.05).The incidences of hepatic vein rupture were 21％ (5/24) in the Pringle's maneuver group and 24％ (6/25)in the SHVO group,with no significant difference (x2=1.45,P＞0.05).The course of 3 patients was complicated by hepatic vein rupture and hemorrhage and 1 by air embolism in the Pringle's maneuver group,while no hemorrhage or air embolism happened in the SHVO group.Four patients in the Pringle's maneuver group and 3 in the SHVO group were found with vascular invasion,while the resection margins were negative.There was no significant difference in the hepatic function in the 2 groups before operation.The levels of alanine aminotransferase in the SHVO group at postoperative day 1 and 3 were significantly lower than those in the Pringle's maneuver group (t=7.12,6.35,P ＜ 0.05).There was no significant difference in the levels of blood urea nitrogen and creatinine between the 2 groups (P ＞ 0.05).Acute hepatic dysfunction was found in 4 patients in the Pringle's maneuver group,but no patients with acute hepatic dysfunction was found in the SHVO group.The 1-and 3-year tumor-free survival rates were 58％ and 21％ in the Pringle's maneuver group,which were significantly lower than 72％ and 30％ in the SHVO group (x2 =5.32,6.07,P ＜ 0.05).The 5-year tumor-free survival rates were 21％ in the Pringle's maneuver group and 20％ in the SHVO group,with no significant difference between the 2 groups (x2 =1.78,P ＞ 0.05).Conclusion SHVO is safe,feasible and effective to prevent hemorrhage and postoperative acute hepatic dysfunction,and it is also helpful in reducing early-stage tumor recurrence and improving the tumor-free survival rate in patients with huge liver cancer.
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