中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2013年
5期
321-324
,共4页
郝胜华%杨湘武%杨文龙%万赤丹
郝勝華%楊湘武%楊文龍%萬赤丹
학성화%양상무%양문룡%만적단
间歇性肝门阻断%原发性肝癌%肝内复发
間歇性肝門阻斷%原髮性肝癌%肝內複髮
간헐성간문조단%원발성간암%간내복발
Intermittent porta hepatis occlusion%Hepatocellular carcinoma%Intra-hepatic recurrence
目的 探讨间歇性肝门阻断对原发性肝癌术后肝内转移的影响.方法 回顾性分析335例原发性肝癌患者临床资料.所有患者均行肝叶切除术,以阻断入肝血流的方法分为两组:(1)间歇性肝门阻断组:97例,Pringle方法间歇性阻断肝门,每个循环阻断15 min,开放5 min.可重复2～3个循环.(2)其他阻断方法(对照)组:238例,包括预处理阻断法、单纯Pringle法、选择性入肝血流阻断法等.术后每4周,定期复查肝脏功能各项指标及甲胎蛋白,肝脏彩色多普勒超声和(或)CT、MRI,平均随访26.5个月.结果 围手术期死亡6例(1.8％).间歇性肝门阻断组1、2年复发率分别为31.6％(30/95)和48.4％(46/95),明显高于对照组的21.4％(50/234)和38.0％(89/234)(P＜0.05).间歇性肝门阻断组1、2年的生存率分别为70.5％(67/95)和53.7％(51/95),与对照组的68.8％(161/234)和55.6％(130/234)比较,无统计学差异(P＞0.05).为排除其他肝内复发相关因素的影响,我们调整了观察病例标准:肿瘤≥5 cm；术后4周AFP降至正常；术中B超阴性.间歇性肝门阻断组与对照组纳入病例分别为79例和155例.结果两组1、2年复发率分别为29.1％比18.7和46.8％比35.5％,间歇性肝门阻断组仍明显高于对照组(P＜0.05),但1、2年生存率无明显差别.结论 间歇性肝门阻断是导致原发性肝癌术后早期肝内复发的一项危险因素,临床应慎用.
目的 探討間歇性肝門阻斷對原髮性肝癌術後肝內轉移的影響.方法 迴顧性分析335例原髮性肝癌患者臨床資料.所有患者均行肝葉切除術,以阻斷入肝血流的方法分為兩組:(1)間歇性肝門阻斷組:97例,Pringle方法間歇性阻斷肝門,每箇循環阻斷15 min,開放5 min.可重複2～3箇循環.(2)其他阻斷方法(對照)組:238例,包括預處理阻斷法、單純Pringle法、選擇性入肝血流阻斷法等.術後每4週,定期複查肝髒功能各項指標及甲胎蛋白,肝髒綵色多普勒超聲和(或)CT、MRI,平均隨訪26.5箇月.結果 圍手術期死亡6例(1.8％).間歇性肝門阻斷組1、2年複髮率分彆為31.6％(30/95)和48.4％(46/95),明顯高于對照組的21.4％(50/234)和38.0％(89/234)(P＜0.05).間歇性肝門阻斷組1、2年的生存率分彆為70.5％(67/95)和53.7％(51/95),與對照組的68.8％(161/234)和55.6％(130/234)比較,無統計學差異(P＞0.05).為排除其他肝內複髮相關因素的影響,我們調整瞭觀察病例標準:腫瘤≥5 cm；術後4週AFP降至正常；術中B超陰性.間歇性肝門阻斷組與對照組納入病例分彆為79例和155例.結果兩組1、2年複髮率分彆為29.1％比18.7和46.8％比35.5％,間歇性肝門阻斷組仍明顯高于對照組(P＜0.05),但1、2年生存率無明顯差彆.結論 間歇性肝門阻斷是導緻原髮性肝癌術後早期肝內複髮的一項危險因素,臨床應慎用.
목적 탐토간헐성간문조단대원발성간암술후간내전이적영향.방법 회고성분석335례원발성간암환자림상자료.소유환자균행간협절제술,이조단입간혈류적방법분위량조:(1)간헐성간문조단조:97례,Pringle방법간헐성조단간문,매개순배조단15 min,개방5 min.가중복2～3개순배.(2)기타조단방법(대조)조:238례,포괄예처리조단법、단순Pringle법、선택성입간혈류조단법등.술후매4주,정기복사간장공능각항지표급갑태단백,간장채색다보륵초성화(혹)CT、MRI,평균수방26.5개월.결과 위수술기사망6례(1.8％).간헐성간문조단조1、2년복발솔분별위31.6％(30/95)화48.4％(46/95),명현고우대조조적21.4％(50/234)화38.0％(89/234)(P＜0.05).간헐성간문조단조1、2년적생존솔분별위70.5％(67/95)화53.7％(51/95),여대조조적68.8％(161/234)화55.6％(130/234)비교,무통계학차이(P＞0.05).위배제기타간내복발상관인소적영향,아문조정료관찰병례표준:종류≥5 cm；술후4주AFP강지정상；술중B초음성.간헐성간문조단조여대조조납입병례분별위79례화155례.결과량조1、2년복발솔분별위29.1％비18.7화46.8％비35.5％,간헐성간문조단조잉명현고우대조조(P＜0.05),단1、2년생존솔무명현차별.결론 간헐성간문조단시도치원발성간암술후조기간내복발적일항위험인소,림상응신용.
Objective To investigate the impact of intermittent porta hepatis occlusion on postoperative intra-hepatic recurrence of hepatocellular carcinoma.Methods We retrospectively reviewed the records of 335 patients who underwent partial hepatectomy.The patients were classified into 2 groups:(1) the study group (n=97):porta hepatis was occluded with intermittent Pringle maneuver with 2-3 cycles of clamp/unclamp time of 15 min/5 min,repeated 2-3cycles; (2) the control group (n=238):including using Pringle maneuver,preconditioning occlusion of porta hepatis and selective occlusion of portal blood inflow.Patients were followed-up in the Outpatient Department once every 2-3 weeks in the 1st year,and once every 3-6 weeks in the 2nd year with US/CT/MRI and serum AFP test.The mean duration of follow-up was 26.5 months.Results The perioperative mortality was 1.8％ (6/335).Tumour recurrence in the study group was 31.6％ and 48.4％ in the 1st and 2nd year,respectively.The recurrence rates were significantly higher,than the 21.4％ and 38.0％ in the control group (P＜0.05).To exclude the miscellaneous factors which were involved in intra-hepatic recurrence of HCC,we set up 3 criteria to include patients for subgroup analysis:tumor ≥5 cm; serum AFP decreased to normal level within 4 weeks; negative intra-operative US scan.The number of patients included were 79 and 155 in the study and the control groups,respectively.There were significant differences in recurrence rate between the study and the control groups in the 1st and 2nd year (29.1％ vs 18.7％,46.8％ vs 35.5％,P＜0.05).There were no significant differences in overall survival rate between the two groups.Conclusions Intermittent porta hepatis occlusion is a risk factor of postoperative intra hepatic recurrence of hepatocellular carcinoma.
