精准肝切除术临床应用
|
摘要
目的探讨精准肝切除术的临床应用价值。方法回顾性分析2014年1月至2017年12月在云南省临沧市人民医院行肝切除术的317例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男202例,女115例;年龄28～78岁,中位年龄47岁。原发病:原发性肝癌207例,肝门部胆管癌6例,胆囊癌8例,肝血管瘤13例,肝内胆管结石73例,肝寄生虫病10例。根据手术方法不同将患者分为精准肝切除组(精准组,171例)和非解剖性肝切除组(对照组,146例)。两组术中出血量、术后住院时间等比较采用t检验,率的比较采用χ~2检验或Fisher确切概率法。结果精准组术中出血量、术后住院时间分别为(528±69)ml、(18.3±2.4)d,明显低于对照组的(827±66)ml、(24.5±3.6)d(t=-3.51,-2.87;P<0.05)。精准组术后出血、胆漏、肝周包裹性积液分别为0、1、2例,对照组相应为1、4、7例,差异有统计学意义(χ~2=-,5.16,4.68;P<0.05)。精准组术后1、2年无瘤生存率和结石复发率分别为73%(82/112)、51%(57/112)、5%(2/39),明显优于对照组的56%(55/99)、40%(40/99)、21%(7/34)(χ~2=4.44,3.82,4.31;P<0.05)。结论精准肝切除术是一种安全、有效的术式,具有术中出血少、术后并发症发生率低、住院时间短、术后无瘤生存率高和结石复发率低优势。
Objective To investigate the application value of precise hepatectomy in clinical practice. Methods Clinical data of 317 patients who underwent hepatectomy in the People's Hospital of Lincang from January 2014 to December 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 202 patients were male and 115 female, aged 28-78 years with a median age of 47 years. Primary diseases: 207 patients were diagnosed with primary liver cancer, 6 cases of hilar cholangiocarcinoma, 8 cases of gallbladder carcinoma, 13 cases of hepatic hemangioma, 73 cases of intrahepatic bile duct stones and 10 cases of hepatic parasitic diseases. All patients were divided into the precise hepatectomy group(precise group,n=171), and non-anatomical hepatectomy groups(control group, n=146) according to different surgical methods. Intraoperative blood loss and postoperative length of hospital stay were compared between two groups by t test. The rate comparison was performed by Chi-square test or Fisher's exact test. Results In precise group, the intraoperative blood loss and postoperative length of hospital stay were(528±69) ml and(18.3±2.4) d respectively, significantly less than(827±66) ml and(24.5±3.6) d in control group(t=-3.51,-2.87; P<0.05). In precise group, no postoperative bleeding, 1 case of bile leakage and 2 cases of perihepatic encapsulated effusion was observed, whereas it was correspondingly 1, 4, 7 cases in control group(χ~2=-, 5.16, 4.68; P<0.05). In precise group, the 1-, 2-year tumor-free survival rates and stone recurrence rate were 73%(82/112), 51%(57/112) and 5%(2/39), significantly better than 56%(55/99), 40%(40/99)and 21%(7/34) in the control group(χ~2=4.44, 3.82, 4.31; P<0.05), respectively. Conclusions Precise hepatectomy is a safe and efficacious surgery, which possesses advantages of slight intraoperative bleeding,low incidence of postoperative complications, short length of hospital stay, high postoperative tumor-free survival rate and low stone recurrence rate.
Objective To investigate the application value of precise hepatectomy in clinical practice. Methods Clinical data of 317 patients who underwent hepatectomy in the People's Hospital of Lincang from January 2014 to December 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 202 patients were male and 115 female, aged 28-78 years with a median age of 47 years. Primary diseases: 207 patients were diagnosed with primary liver cancer, 6 cases of hilar cholangiocarcinoma, 8 cases of gallbladder carcinoma, 13 cases of hepatic hemangioma, 73 cases of intrahepatic bile duct stones and 10 cases of hepatic parasitic diseases. All patients were divided into the precise hepatectomy group(precise group,n=171), and non-anatomical hepatectomy groups(control group, n=146) according to different surgical methods. Intraoperative blood loss and postoperative length of hospital stay were compared between two groups by t test. The rate comparison was performed by Chi-square test or Fisher's exact test. Results In precise group, the intraoperative blood loss and postoperative length of hospital stay were(528±69) ml and(18.3±2.4) d respectively, significantly less than(827±66) ml and(24.5±3.6) d in control group(t=-3.51,-2.87; P<0.05). In precise group, no postoperative bleeding, 1 case of bile leakage and 2 cases of perihepatic encapsulated effusion was observed, whereas it was correspondingly 1, 4, 7 cases in control group(χ~2=-, 5.16, 4.68; P<0.05). In precise group, the 1-, 2-year tumor-free survival rates and stone recurrence rate were 73%(82/112), 51%(57/112) and 5%(2/39), significantly better than 56%(55/99), 40%(40/99)and 21%(7/34) in the control group(χ~2=4.44, 3.82, 4.31; P<0.05), respectively. Conclusions Precise hepatectomy is a safe and efficacious surgery, which possesses advantages of slight intraoperative bleeding,low incidence of postoperative complications, short length of hospital stay, high postoperative tumor-free survival rate and low stone recurrence rate.
引文
[1]王新青,卜阳,于松宁,等.精准肝切除治疗原发性肝癌近期疗效的Meta分析[J].中国普通外科杂志,2016,25(1):57-66.
[2]荚卫东,乔晓斐.加速康复外科理念在精准肝切除治疗肝细胞癌中的应用策略[J].中国实用外科杂志,2016,36(6):692-694.
[3]肖卫星,周君,顾梦佳,等.精准肝切除在肝内胆管结石手术治疗中的应用[J].中国普通外科杂志,2016,25(2):191-196.
[4]张松,潘树波,谢坤,等.精准肝脏外科理念在肝细胞肝癌治疗中的价值[J].安徽医科大学学报,2016,51(1):94-97.
[5]Meniconi RL,Komatsu S,Perdigao F,et al.Recurrent hepatocellular carcinoma:a Western strategy that emphasizes the impact of pathologic profile of the first resection[J].Surgery,2015,157(3):454-462.
[6]中国研究型医院学会肝胆胰外科专业委员会.精准肝切除术专家共识[J].中华消化外科杂志,2017,16(9):883-893.
[7]沈锋,张小峰.原发性肝癌肝切除术质量控制若干问题[J].中国实用外科杂志,2016,36(1):11-14.
[8]李幼安,张起帆,蔡庆,等.原发性肝癌精准肝切除与不规则性肝切除的对比研究[J].实用医学杂志,2017,33(20):3429-3433.
[9]李留峥,徐雷升,俸家伟,等.Glisson蒂横断式解剖性肝切除120例体会[J].肝胆胰外科杂志,2017,29(5):359-362,367.
[10]李留峥,徐雷升,俸家伟,等.解剖性肝切除术治疗复杂肝内胆管结石体会[J].腹部外科,2017,30(6):456-459,463.
[11]张红卫,李闻达,曹君,等.3D腹腔镜下解剖性肝切除术治疗肝脏肿瘤的应用价值[J/CD].中华肝脏外科手术学电子杂志,2014,3(3):152-156.
[12]张朋飞,于松宁,雷鹏,等.3D打印技术在精准肝切除术前评估的应用[J].中国普通外科杂志,2017,26(7):831-837.
[13]成伟,左芝,刘毅,等.腹腔镜循肝静脉入路解剖性肝切除术97例疗效分析[J].中国实用外科杂志,2017,37(5):555-558.
[14]Makuuchi M.Surgical treatment for HCC--special reference to anatomical resection[J].Int J Surg,2013,11 Suppl 1:S47-49.
[15]蔡邢峰,陈钟.肝细胞肝癌精准治疗的现状和展望[J].南通大学学报(医学版),2017,37(3):247-252.
[16]魏晓平,胡明道,于恒海,等.精准肝切除与常规肝切除对肝癌患者T细胞亚群变化影响的比较[J].中国普通外科杂志,2017,26(7):855-860.
[17]Yang W,Yan K,Wang S,et al.Differential diagnosis of arterial phase enhanced hepatic inflammatory lesions and hepatocellular carcinomas with contrast-enhanced ultrasound[J].Ultrasound Med Biol,2016,42(1):82-91.
[18]黄锦龙,王清,于勇,等.解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2015,36(5):492-499.
[19]罗翠松,林云,曾志峰,等.倾向值匹配法评价解剖性肝切除和非解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2016,37(12):1568-1573.
[20]李博,李昆仑.不同技术在精准肝切除术中应用价值比较[J].肝胆外科杂志,2017,25(1):60-62,65.
[2]荚卫东,乔晓斐.加速康复外科理念在精准肝切除治疗肝细胞癌中的应用策略[J].中国实用外科杂志,2016,36(6):692-694.
[3]肖卫星,周君,顾梦佳,等.精准肝切除在肝内胆管结石手术治疗中的应用[J].中国普通外科杂志,2016,25(2):191-196.
[4]张松,潘树波,谢坤,等.精准肝脏外科理念在肝细胞肝癌治疗中的价值[J].安徽医科大学学报,2016,51(1):94-97.
[5]Meniconi RL,Komatsu S,Perdigao F,et al.Recurrent hepatocellular carcinoma:a Western strategy that emphasizes the impact of pathologic profile of the first resection[J].Surgery,2015,157(3):454-462.
[6]中国研究型医院学会肝胆胰外科专业委员会.精准肝切除术专家共识[J].中华消化外科杂志,2017,16(9):883-893.
[7]沈锋,张小峰.原发性肝癌肝切除术质量控制若干问题[J].中国实用外科杂志,2016,36(1):11-14.
[8]李幼安,张起帆,蔡庆,等.原发性肝癌精准肝切除与不规则性肝切除的对比研究[J].实用医学杂志,2017,33(20):3429-3433.
[9]李留峥,徐雷升,俸家伟,等.Glisson蒂横断式解剖性肝切除120例体会[J].肝胆胰外科杂志,2017,29(5):359-362,367.
[10]李留峥,徐雷升,俸家伟,等.解剖性肝切除术治疗复杂肝内胆管结石体会[J].腹部外科,2017,30(6):456-459,463.
[11]张红卫,李闻达,曹君,等.3D腹腔镜下解剖性肝切除术治疗肝脏肿瘤的应用价值[J/CD].中华肝脏外科手术学电子杂志,2014,3(3):152-156.
[12]张朋飞,于松宁,雷鹏,等.3D打印技术在精准肝切除术前评估的应用[J].中国普通外科杂志,2017,26(7):831-837.
[13]成伟,左芝,刘毅,等.腹腔镜循肝静脉入路解剖性肝切除术97例疗效分析[J].中国实用外科杂志,2017,37(5):555-558.
[14]Makuuchi M.Surgical treatment for HCC--special reference to anatomical resection[J].Int J Surg,2013,11 Suppl 1:S47-49.
[15]蔡邢峰,陈钟.肝细胞肝癌精准治疗的现状和展望[J].南通大学学报(医学版),2017,37(3):247-252.
[16]魏晓平,胡明道,于恒海,等.精准肝切除与常规肝切除对肝癌患者T细胞亚群变化影响的比较[J].中国普通外科杂志,2017,26(7):855-860.
[17]Yang W,Yan K,Wang S,et al.Differential diagnosis of arterial phase enhanced hepatic inflammatory lesions and hepatocellular carcinomas with contrast-enhanced ultrasound[J].Ultrasound Med Biol,2016,42(1):82-91.
[18]黄锦龙,王清,于勇,等.解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2015,36(5):492-499.
[19]罗翠松,林云,曾志峰,等.倾向值匹配法评价解剖性肝切除和非解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2016,37(12):1568-1573.
[20]李博,李昆仑.不同技术在精准肝切除术中应用价值比较[J].肝胆外科杂志,2017,25(1):60-62,65.