CAJ | 학술논문

目的探讨精准肝脏外科理念在原发性肝癌治疗中的临床价值.方法回顾性分析2009年1月至201 1年10月解放军第八十一医院收治的141例原发性肝癌患者的临床资料.术前对患者行CT等检查收集二维影像学数据进行三维重建,根据患者情况选择性行肝脏储备功能评估,模拟手术操作以制订手术方案.术中结合彩色多普勒超声探查,选择性阻断肝血流,根据患者情况选择行解剖性肝切除术或非解剖性局部肝切除术.采用电话和门诊进行随访,随访时间截至2014年1月.采用Kaplan-Meier法计算生存率.结果 77例患者术前完成三维重建,39例患者行ICG R15检查,95例患者在术中行彩色多普勒超声探查.141例患者均成功完成手术,采用Pringle法行入肝血流全阻断4例、肝蒂部分阻断48例、未行肝门阻断89例.其中行解剖性肝切除术者占85.11％(120/141).手术时间为(188±56)min,术中出血量为(230±100) mL,围手术期输血者12例,术后当日腹腔引流量为(147 ±58)mL.术后ALT、AST和TBil峰值分别为(219±121)U/L、(214±104) U/L和(32±14) μmol/L.术后8例患者发生胸腔积液、膈下感染、腹腔积液、胆汁漏等并发症,5例发生肺部感染、切口感染等,并发症发生率为9.22％(13/141).所有并发症经对症治疗后痊愈,尢肝衰竭和围手术期死亡发生.术后住院时间为(11.0 ±2.6)d.术后病理检查结果示肝细胞癌130例、胆管细胞癌11例,切除肿瘤直径为(5.8 ±1.7)cm,其中1例患者切缘阳性.138例患者获得随访,随访时间为(40±10)个月,患者术后1、2、3年生存率分别为91.5％、75.9％和65.2％,生存时间为(43±5)个月.结论精准肝脏外科理念运用于原发性肝癌的治疗,术后并发症少,近、远期疗效好.
목적 탐토정준간장외과이념재원발성간암치료중적림상개치.방법 회고성분석2009년1월지201 1년10월해방군제팔십일의원수치적141례원발성간암환자적림상자료.술전대환자행CT등검사수집이유영상학수거진행삼유중건,근거환자정황선택성행간장저비공능평고,모의수술조작이제정수술방안.술중결합채색다보륵초성탐사,선택성조단간혈류,근거환자정황선택행해부성간절제술혹비해부성국부간절제술.채용전화화문진진행수방,수방시간절지2014년1월.채용Kaplan-Meier법계산생존솔.결과 77례환자술전완성삼유중건,39례환자행ICG R15검사,95례환자재술중행채색다보륵초성탐사.141례환자균성공완성수술,채용Pringle법행입간혈류전조단4례、간체부분조단48례、미행간문조단89례.기중행해부성간절제술자점85.11％(120/141).수술시간위(188±56)min,술중출혈량위(230±100) mL,위수술기수혈자12례,술후당일복강인류량위(147 ±58)mL.술후ALT、AST화TBil봉치분별위(219±121)U/L、(214±104) U/L화(32±14) μmol/L.술후8례환자발생흉강적액、격하감염、복강적액、담즙루등병발증,5례발생폐부감염、절구감염등,병발증발생솔위9.22％(13/141).소유병발증경대증치료후전유,왕간쇠갈화위수술기사망발생.술후주원시간위(11.0 ±2.6)d.술후병리검사결과시간세포암130례、담관세포암11례,절제종류직경위(5.8 ±1.7)cm,기중1례환자절연양성.138례환자획득수방,수방시간위(40±10)개월,환자술후1、2、3년생존솔분별위91.5％、75.9％화65.2％,생존시간위(43±5)개월.결론 정준간장외과이념운용우원발성간암적치료,술후병발증소,근、원기료효호.
Objective To investigate the clinical value of precision liver surgery concept in the treatment of primary liver cancer.Methods The clinical data of 141 patients with primary liver cancer who were admitted to the No.81 Hospital of PLA from January 2009 to October 2011 were retrospectively analyzed.The three-dimensional reconstruction,preoperative evaluation and virtual surgery were done based on the data of imaging examination.Hepatic functional reserve evaluation was done based on the condition of patients.The blood flow was occluded in selected patients according to the results of ultrasonography,and the tumor was anatomically resected.Patients were followed up via phone call or out-patient examination till January 2014.The survival rate was calculated by Kaplan-Meier method.Results Three-dimensional reconstruction was done in 77 patients preoperatively.Thirty-nine patients received ICG R15 test to detect the liver functional reserve and 95 received intraoperative color Doppler uhrasonography.The operation was successfully done on 141 patients.Four patients underwent total inflow occlusion,48 underwent partial inflow occlusion in the hepatic pedicle by Pringle maneuver.Eighty-nine patients did not receive inflow occlusion.The proportion of patients who received anatomical hepatectomy was 85.11％ (120/141).The operation time,volume of intraoperative blood loss,number of patients who received blood transfusion,volume of peritoneal drainage at postoperative day 0 were (188 ± 56) minutes,(230 ± 100) mL,12 and (147 ± 58)mL,respectively.The peak levels of postoperative alanine transaminase,aspartate transaminasc and total bilirubin were (219 ± 121) U/L,(214 ± 104) U/L and (32 ± 14) μmol/L,respectively.Eight patients were complicated with thoracic effusion,subphrenic infection,peritoneal effusion and bile leakage,and 5 patients were complicated with pulmonary infection and incisional infection,with the complication rate of 9.22％ (13/141) after the operation.All the patients were cured after symptomatic treatment,without occurrence of hepatic failure or perioperative death.The duration of postoperative hospital stay was (11.0 ± 2.6) days.There were 130 patients with hepatocellular carcinoma and 11 patients with cholangiocarcinoma.The mean diameter of tumors resected was (5.8 ± 1.7) cm,and the resection margin of 1 patient was positive.One hundred and thirty eight patients were followed up for (40 ± 10) months,and the 1-,2-,3-year survival rates were 91.5％,75.9％and 65.2％,and the survival time was (43 ± 5) months.Conclusion Precision liver surgery has advantages of few postoperative complications and better short-and long-term efficacy.