不阻断肝门肝切除术在肝癌治疗临床应用研究
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摘要
目的探讨肝癌采用不阻断肝门切除术治疗临床效果。方法选取2011年6月~2016年6月连云港市第二人民医院肝胆外科行肝切除术的原发性肝癌患者41例,随机分为肝门阻断组(阻断组)21例和不阻断肝门组(不阻断组)20例,阻断组术中采用全肝入肝血流阻断,不阻断组术中不阻断入肝血流,比较两组临床资料。结果两组术中出血量、手术时间差异无统计学意义(P>0.05)。术后住院时间不阻断组明显少于阻断组(P<0.05)。两组术前白蛋白(ALB)、总胆红素(TBIL)及谷丙转氨酶(ALT)均差异无统计学意义(P>0.05),而术后1d及7d阻断组TBIL、ALT均显著高于不阻断组,ALB显著低于不阻断组,有统计学差异(P<0.05)。阻断组并发症发生率为38.1%,而不阻断组为5%,明显低于阻断组(P<0.05)。结论采用不阻断肝门肝切除治疗肝癌具有一定的安全性和可行性,减少了对肝功能的影响,降低了术后并发症发生率,相对安全可靠,可操作性强,值得在临床推广应用。
Objective To investigate clinical effect of non-blocking hepatic resection in treatment of liver cancer. Methods 41 cases of primary liver cancer carried on liver resection in Department of Hepatobiliary Surgery of Lianyungang Second People's Hospital from June 2011 to June 2016 were selected and randomly divided into blocking hepatic portal group(blocking group) with 21 cases and non-blocking hepatic portal group(non-blocking group) with 20 cases. Liver blood flow was used in blocking group during the operation, and liver blood flow was not blocking-up in non-blocking group during operation. Clinical data of the two groups were compared. Results There was no difference in average amount of bleeding and operation duration(P > 0.05). Hospital time of non-blocking group were obviously fewer than that of blocking group(P < 0.05).There were no significantly statistical differences in preoperative albumin(ALB), total bilirubin(TBIL) and alanine aminotransferase(ALT) between the two groups(P >0.05), while the TBIL and ALT of blocking group was higher than thao of non-blocking group on postoperative 1d and 7 d,but the ALB of block group was higher than that of non-blocking group,and it is significantly different(P < 0.05).The complication rate of blocking group was 38.1%, which was significantly higher than that of non-blocking group(5%)(P < 0.05). Conclusion Hepatectomy for primary liver cancer without blocking hepatic portal has certain safety and feasibility. It can reduce the influence on liver function and decrease the incidence of postoperative complication. The case shows that the technique with relative safety and reliability was suitable for operation, and it is worth to be spread and clinical application.
Objective To investigate clinical effect of non-blocking hepatic resection in treatment of liver cancer. Methods 41 cases of primary liver cancer carried on liver resection in Department of Hepatobiliary Surgery of Lianyungang Second People's Hospital from June 2011 to June 2016 were selected and randomly divided into blocking hepatic portal group(blocking group) with 21 cases and non-blocking hepatic portal group(non-blocking group) with 20 cases. Liver blood flow was used in blocking group during the operation, and liver blood flow was not blocking-up in non-blocking group during operation. Clinical data of the two groups were compared. Results There was no difference in average amount of bleeding and operation duration(P > 0.05). Hospital time of non-blocking group were obviously fewer than that of blocking group(P < 0.05).There were no significantly statistical differences in preoperative albumin(ALB), total bilirubin(TBIL) and alanine aminotransferase(ALT) between the two groups(P >0.05), while the TBIL and ALT of blocking group was higher than thao of non-blocking group on postoperative 1d and 7 d,but the ALB of block group was higher than that of non-blocking group,and it is significantly different(P < 0.05).The complication rate of blocking group was 38.1%, which was significantly higher than that of non-blocking group(5%)(P < 0.05). Conclusion Hepatectomy for primary liver cancer without blocking hepatic portal has certain safety and feasibility. It can reduce the influence on liver function and decrease the incidence of postoperative complication. The case shows that the technique with relative safety and reliability was suitable for operation, and it is worth to be spread and clinical application.
引文
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[12]郝胜华,杨湘武,杨文龙,等.间歇性肝门阻断是原发性肝癌术后早期肝内复发的一项危险因素[J].中华肝胆外科杂志,2013;19(5):321-324.
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[14]严律南,曾勇,林琦远,等.半肝血流阻断下肝能量代谢变化的研究[J].中华肝胆外科杂志.2000,6(1):10-12.
[15]杨欢,王智鹏,张金辉.肝脏外科血流阻断与重建:技术进展及研究热点[J].中国组织工程研究,2014,18(46):7503-7508.
[16]陈孝平,张志伟.肝血流阻断方法和选择原则[J].中国医学信息导报,2011,26(18):11.
[2]Venook AP,Papandreou C,Furuse J,et al.The incidence and epidemiology of hepatocellular carcinoma:a global and regional perspective[J].The Oncologist,2010,15(4):5-13.
[3]吴若林,耿小平,赵红川,等.肝中叶切除术治疗中央区大肝癌25例临床分析[J].中华普通外科杂志,2013,28(3):200-204.
[4]祝明华,江寅芳,杨运海.肝癌术后孤立性肺转移灶切除术的临床应用[J].医学研究杂志,2013,42(5):117-119.
[5]Liang G,Wen T,Yan L,et al.A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors[J].Hepatogastroenterology,2009,56(91-92):745-750.
[6]陈孝平,汪健平.外科学[M].第8版.北京:人民卫生出版社,2013:432-434.
[7]董科,温尔刚,俞小炯.不同肝血流阻断技术在肝切除中应用的临床研究[J].四川医学,2010,31(12):1731-1734.
[8]Huang JF,Wu SM,Wu TH,et al.Liver resection for complicated hepatocellular carcinoma:challenges but opportunity for long-term survivals[J].J Surg Oncol,2012,106(8):959-965.
[9]章跃民,杨杰,尚现章,等.前入路半肝血流阻断法在巨块型肝癌规则性肝切除术中的应用[J].中国普通外科杂志,2011,20(7):781-783.
[10]Strobel O,Büchler MW.Intermittent Pringle manoeuvre:no reduction of blood loss according to recent RCT[J].Chirurg,2012,83(11):994.
[11]Sanjay P,Ong I,Bartlett A,et al.Meta-analysis of intermittent Pringle manoeuvre versus no Pringle manoeuvre in elective liver surgery[J].ANZ J Surg,2013,83(10):719-723.
[12]郝胜华,杨湘武,杨文龙,等.间歇性肝门阻断是原发性肝癌术后早期肝内复发的一项危险因素[J].中华肝胆外科杂志,2013;19(5):321-324.
[13]Fu SY,Lau WY,Li GG,et al,A prospective randomized controlled trial to compare Pringle maneuver,hemihepatic vascular inflow occlusion,and main portal vein inflowocclusion in partial hepatectomy[J].Am J surg,2011,201(1):62-69.
[14]严律南,曾勇,林琦远,等.半肝血流阻断下肝能量代谢变化的研究[J].中华肝胆外科杂志.2000,6(1):10-12.
[15]杨欢,王智鹏,张金辉.肝脏外科血流阻断与重建:技术进展及研究热点[J].中国组织工程研究,2014,18(46):7503-7508.
[16]陈孝平,张志伟.肝血流阻断方法和选择原则[J].中国医学信息导报,2011,26(18):11.