CAJ | 학술논문

目的：探讨术前行介入治疗的肝细胞癌（ HCC）患者手术风险、围手术期转归及应对措施。方法采用回顾性病例配对研究的方法，比较术前介入治疗组与未行介入治疗的配对对照组患者的围手术期转归特点及应对措施。共纳入手术患者105例（其中82例患者采用肝区域选择性适时血流阻断的方法行复杂肿瘤的肝切除），按1∶2配对，介入治疗组患者35例，配对对照组患者70例。结果介入治疗组患者术前γ?谷氨酰转肽酶水平为（119．52±98．83） U／L，明显高于配对对照组[（67．39±61．25）U／L，P＝0．040]。介入治疗组患者的手术时间为（232．60±95．43）min，较配对对照组[（218．70±75．13）]min延长，但差异并无统计学意义（P＝0．052）。介入治疗组患者术后肝功能的恢复情况与配对对照组患者的差异无统计学意义（均P＞0．05）。介入治疗组和配对对照组患者均无大出血、胆瘘和30 d内死亡病例。结论术前介入治疗对HCC患者的肝功能有一定的不利影响，应用肝区域选择性适时血流阻断的方法及合理的围手术期治疗，能够保障HCC患者手术的安全性，促进患者的快速康复。
목적：탐토술전행개입치료적간세포암（ HCC）환자수술풍험、위수술기전귀급응대조시。방법채용회고성병례배대연구적방법，비교술전개입치료조여미행개입치료적배대대조조환자적위수술기전귀특점급응대조시。공납입수술환자105례（기중82례환자채용간구역선택성괄시혈류조단적방법행복잡종류적간절제），안1∶2배대，개입치료조환자35례，배대대조조환자70례。결과개입치료조환자술전γ?곡안선전태매수평위（119．52±98．83） U／L，명현고우배대대조조[（67．39±61．25）U／L，P＝0．040]。개입치료조환자적수술시간위（232．60±95．43）min，교배대대조조[（218．70±75．13）]min연장，단차이병무통계학의의（P＝0．052）。개입치료조환자술후간공능적회복정황여배대대조조환자적차이무통계학의의（균P＞0．05）。개입치료조화배대대조조환자균무대출혈、담루화30 d내사망병례。결론술전개입치료대HCC환자적간공능유일정적불리영향，응용간구역선택성괄시혈류조단적방법급합리적위수술기치료，능구보장HCC환자수술적안전성，촉진환자적쾌속강복。
Objective To explore the surgical risk, perioperative outcome and the response of patients with hepatocellular carcinoma ( HCC ) after preoperative transcatheter arterial chemoembolization ( TACE) . Methods A retrospective case?matched study was conducted to compare the characteristics and corresponding measures of patients in the preoperative TACE group and the control group without TACE. A total of 105 patients ( 82 patients with selective and dynamic region?specific vascular occlusion to perform hepatectomy for patients with complex hepatocellular carcinoma) was included in this study, in which 35 patients underwent TACE therapy, and a 1 ∶ 2 matched control group of 70 subjects. Results The patients of preoperative TACE therapy group had a higher level of γ?glutamyl transpeptidase before operation (119.52± 98.83)U/L vs. (67.39±61.25) U/L (P=0.040). The operation time was longer in the TACE group than that in the control group but with a non?significant difference (232.60±95.43) min vs. (218.70±75.13) min ( P=0.052) . The postoperative recovery of liver function and severe complications in the preoperative TACE group were similar to that in the control group ( P>0.05) . There were no massive hemorrhage, biliary fistula and 30?d death neither in the treatment group and matched control group. Conclusions Preoperative TACE therapy has certain negative effect on liver function. It is preferable to use selective and dynamic region?specific vascular occlusion technique during hepatectomy and combine with reasonable perioperative treatment for this group of patients, that can ensure safety of patients and promote their rapid recovery.