交替阻断半肝入肝血流在解剖性肝中叶切除术中的应用
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摘要
目的探讨交替阻断半肝入肝血流在解剖性肝中叶切除术中的应用和优势。方法回顾性分析2014年1月至2017年12月于福州总医院肝胆外科行肝中叶切除术的57例肝癌患者的临床资料。按照手术方式不同分为观察组和对照组,观察组34例患者应用交替阻断半肝入肝血流技术行解剖性肝中叶切除术,对照组23例患者行非解剖性肝中叶切除术,比较2组患者的临床效果。结果观察组在手术时间、术中出血量、住院时间、住院费用、术后第1、3、5天白蛋白(ALB)、术后第1、3、5、7天谷丙转氨酶(ALT)和谷草转氨酶(AST)等指标上明显优于对照组,差异具有统计学意义(P<0.05),2组患者均无围手术期死亡病例。结论在解剖性肝中叶切除术中应用交替阻断半肝入肝血流技术可以获得良好的近期疗效,且安全性高。
Objective To investigate the application and advantages of alternative vascular hemihepatic occlusion in anatomic mesohepatectomy.Methods The clinical data of 57 patients with liver cancer who underwent operation in hepatobiliary surgery of Fuzhou general hospital from January 2014 to December 2017 were retrospectively analyzed.According to the surgery method,the patients were divided into observation group and control group,34 cases in observation group were performed anatomic mesohepatectomy with alternative hemihepatic occlusion,23 cases in control group were treated with non-anatomical liver lobectomy.The clinical effect of two groups were compared.Results The observation group was significantly better than the control group in terms of operation time,intraoperative blood loss,length of hospital stay,hospitalization costs,ALB at 1,3,5 days after surgery,ALT and AST at 1,3,5,7 days after surgery,the differences were significant(P<0.05).There was no perioperative deaths in the two groups.Conclusion Applied alternative hemihepatic vascular occlusion in anatomic mesohepatectomy can achieve good short-term curative effect and high safety.
Objective To investigate the application and advantages of alternative vascular hemihepatic occlusion in anatomic mesohepatectomy.Methods The clinical data of 57 patients with liver cancer who underwent operation in hepatobiliary surgery of Fuzhou general hospital from January 2014 to December 2017 were retrospectively analyzed.According to the surgery method,the patients were divided into observation group and control group,34 cases in observation group were performed anatomic mesohepatectomy with alternative hemihepatic occlusion,23 cases in control group were treated with non-anatomical liver lobectomy.The clinical effect of two groups were compared.Results The observation group was significantly better than the control group in terms of operation time,intraoperative blood loss,length of hospital stay,hospitalization costs,ALB at 1,3,5 days after surgery,ALT and AST at 1,3,5,7 days after surgery,the differences were significant(P<0.05).There was no perioperative deaths in the two groups.Conclusion Applied alternative hemihepatic vascular occlusion in anatomic mesohepatectomy can achieve good short-term curative effect and high safety.
引文
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[16]黄兴华,胡还章,江艺.半肝入肝血流阻断法与第一肝门血流阻断法在肝癌切除术中应用的比较[J].中华解剖与临床杂志,2015,20(6):546-551.doi:10.3760/cma.j.issn.2095-7041.2015.06.014.
[17]刘斌,李江,蔡晓蓓,等.解剖性肝中叶切除治疗中央型巨大肝癌[J].中华消化外科杂志,2012,11(6):552-555.doi:10.3760/cma.j.issn.1673-9752.2012.06.016.
[18]严广,黄志华,葛新国,等.中央型原发性肝癌42例外科治疗体会[J].中华普通外科杂志,2011,26(1):68-69.doi:10.3760/cma.j.issn.1007-631X.2011.01.024.
[19]陈海敏,高夫生,方路,等.肝叶血流阻断在右肝解剖性肝切除中的应用:附12例报告[J].中国普通外科杂志,2017,27(1):15-21.doi:10.3978/.2018.01.003.
[20]Oiu Y,Zhu X,Zhu R,et al.The clinical study of precise hemihepatectomy guided by middle hepatic vein[J].World J Surg,2012,36(10):2428-2435.doi:10.1007/s00268-012-1662-5.
[21]贾长库,陈有科,韩霖,等.交替半肝入肝血流阻断解剖性肝中叶切除[J].中国普通外科杂志,2015,24(1):121-126.doi:10.3978/j.issn.1005-6947.2015.01.023.
[2]Poon D,Anerson BD,Chen LT,et al.Management of hepatocellular carcinoma in Asia:consensus statement from the Asian Oncology Summit[J].Lancet Oncol,2009,10(11):1111-1118.doi:10.1016/S1470-2045(09)70241-4.
[3]戴朝六,彭松林,贾昌俊,等.中央区肝癌肝切除的手术体会[J].中国医学科学院学报,2008,30(4):460-464.doi:10.3321/j.issn:1000-503X.2008.04.020.
[4]Ken takasaki.Glisson蒂横断式肝切除术[M].北京:人民卫生出版社,2008:3-39.
[5]唐诗彬,陈小伍,吴路杨,等.Glisson鞘解剖性肝切除术治疗肝内胆管结石[J].中华肝脏外科手术学电子杂志,2016,5(3):148-152.doi:10.3877/cma.j.issn.2095-3232.2016.03.006.
[6]吴宝强,江勇,朱峰,等.Glisson蒂横断式肝切除在解剖性肝切术中的应用[J].肝胆胰外科杂志,2013,25(3):185-187.doi:10.3969/j.issn.1007-1954.2013.03.003.
[7]黎焕,江勇,吴宝强,等.Glisson蒂横断式肝切除术治疗肝占位性疾病的初步应用[J].肝胆胰外科杂志,2012,24(6):447-450.doi:10.3969/j.issn.1007-1954.2012.06.003.
[8]谭新华,莫世发,韦杨年,等.美兰染色标记法联合Glisson蒂横断式肝切除与非规则性肝切除治疗肝癌的临床疗效[J].中国癌症防治杂志,2015,7(2):104-108.doi:10.3969/j.issn.1674-5671.2015.02.08.
[9]Xia F,Lau WY,Xu Y,et al.Does hepatic ischemia-reperfusion injury induced by hepatic pedicle clamping affect survival after partial hepatectomy for hepatocellular carcinoma?[J].World J Surg,2013,37(1):192-201.doi:10.1007/s00268-012-1781-z.
[10]Dillner J,Meyer F,Lippert H,et al.Organ-invasive carcinoma of the pararenal gland involving the inferior vena cava:successful curative and interdisciplinary surgical management[J].Dtsch Med Wochenschr,2013,138(6):260-265.doi:10.1055/s-0032-1332842.
[11]祝根飞,林建宇,毛谅,等.精准肝蒂解剖法肝段切除术的临床疗效分析[J].中华肝胆外科杂志,2013,19(5):343-348.doi:10.3760/cam.j.issn.1007-8118.2013.05.007.
[12]吴建雄,余微波.中央型肝癌治疗理念的开拓与创新[J].肝胆胰外科杂志,2013,25(3):177-181.doi:10.3969/j.issn.1007-1954.2013.03.001.
[13]张成武,刘杰,赵大建.肝中叶切除术的临床应用[J].肝胆胰外科杂志,2013,25(4):272-275.doi:10.3969/j.issn.1007-1954.2013.04.003.
[14]Beard RE,Hanto DW,Gautam S,et al.A comparison of surgical outcomes for noncirrhotic and cirrhotic hepatocellular carcinoma patients in a Western institution[J].Surgery,2013,154(3):545-555.doi:10.1016/j.surg.2013.02.019.
[15]Boleslawski E,Decanter G,Truant S,et al.Right hepatectomy with extra-hepatic vascular division prior to transection:intention-to-treat analysis of a standardized policy[J].HPB(Oxford),2012,14(10):688-699.doi:10.1111/j.1477-2574.2012.00519.x.
[16]黄兴华,胡还章,江艺.半肝入肝血流阻断法与第一肝门血流阻断法在肝癌切除术中应用的比较[J].中华解剖与临床杂志,2015,20(6):546-551.doi:10.3760/cma.j.issn.2095-7041.2015.06.014.
[17]刘斌,李江,蔡晓蓓,等.解剖性肝中叶切除治疗中央型巨大肝癌[J].中华消化外科杂志,2012,11(6):552-555.doi:10.3760/cma.j.issn.1673-9752.2012.06.016.
[18]严广,黄志华,葛新国,等.中央型原发性肝癌42例外科治疗体会[J].中华普通外科杂志,2011,26(1):68-69.doi:10.3760/cma.j.issn.1007-631X.2011.01.024.
[19]陈海敏,高夫生,方路,等.肝叶血流阻断在右肝解剖性肝切除中的应用:附12例报告[J].中国普通外科杂志,2017,27(1):15-21.doi:10.3978/.2018.01.003.
[20]Oiu Y,Zhu X,Zhu R,et al.The clinical study of precise hemihepatectomy guided by middle hepatic vein[J].World J Surg,2012,36(10):2428-2435.doi:10.1007/s00268-012-1662-5.
[21]贾长库,陈有科,韩霖,等.交替半肝入肝血流阻断解剖性肝中叶切除[J].中国普通外科杂志,2015,24(1):121-126.doi:10.3978/j.issn.1005-6947.2015.01.023.