Glisson蒂阻断术式对原发性肝癌患者的疗效及预后的影响
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摘要
目的探讨Glisson蒂阻断术式对原发性肝癌患者的疗效及预后的影响,为治疗原发性肝癌提供临床指导。方法回顾性分析2014年1月至2015年1月在三峡大学第二人民医院普外二科住院治疗的60例患者的临床资料,依据手术方法不同分为观察组和对照组,每组30例。对照组采用Pringle法阻断第一肝门手术治疗,观察组采用Glisson蒂阻断手术治疗。比较两组患者的手术时间、手术出血量、术中输血量、肝血流阻断、肝功能相关指标、术后并发症以及术后生存率。结果观察组患者肝血流阻断时间为(31.5±8.9) min,与对照组的(29.8±8.2) min比较差异无统计学意义(P>0.05);观察组患者的手术时间和住院时间分别为(82.6±3.4) min、(11.3±2.1) d,明显短于对照组的(105.1±2.4) min和(15.2±2.5) d,差异均有统计学意义(P<0.05);观察组患者手术出血量和术中输血量分别为(133.5±24.4) mL、(197.3±12.3) mL,明显低于对照组的(184.3±30.1) mL和(258.1±14.6) mL,差异均有统计学意义(P<0.05);术后,两组患者的谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、凝血酶原时间(PT)均明显升高,且观察组ALT、AST、TBIL、PT明显高于对照组,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率为6.7%,明显低于对照组的13.3%,术后3年生存率的70.0%,明显高于对照组的50.0%,差异均有统计学意义(P<0.05)。结论 Glisson蒂阻断术治疗原发性肝癌患者具有出血少、手术时间短、恢复快、并发症少的优点,同时可以有效改善肝功能,提高生存率,值得临床上推广。
Objective To explore the effect of Glisson's pedicle occlusion on the curative effect and prognosis of patients with primary liver cancer, and to provide clinical guidance for the treatment of primary liver cancer.Methods The clinical data of 60 patients were retrospectively analyzed, who were hospitalized in the Second Department of General Surgery at the Second People's Hospital of Three Gorges University from January 2014 to January2015. According to different surgical methods, the patients were divided into observation group and control group, with30 cases in each group. The control group was treated with Pringle method for blocking the first hepatic portal operation,and the observation group was treated with Glisson pedicle blocking operation. The operation time, bleeding volume, intraoperative blood transfusion volume, hepatic blood flow occlusion, liver function related indicators, postoperative complications, and postoperative survival rate were compared between the two groups. Results The time of hepatic blood flow occlusion in the observation group was(31.5±8.9) min, which was not statistically significant compared with(29.8±8.2) min in the control group(P>0.05). The operation time and hospitalization time in the observation group were(82.6±3.4) min and(11.3±2.1) d, respectively, which were significantly shorter than corresponding(105.1±2.4) min and(15.2±2.5) d in the control group(P<0.05). The bleeding volume and intraoperative blood transfusion volume in the observation group were respectively(133.5 ± 24.4) mL,(197.3 ± 12.3) mL, which were significantly lower than corresponding(184.3±30.1) mL and(258.1±14.6) m L in the control group(P<0.05). After operation, alanine aminotransferase(ALT),aspartate aminotransferase(AST), total bilirubin(TBIL), and prothrombin time(PT) were significantly elevated in the two groups; and the ALT, AST, TBIL and PT in the observation group were significantly higher than those in the control group(P<0.05). The incidence of postoperative complications in the observation group was 6.7%, which was significantly lower than 13.3% in the control group; and the postoperative 3-year survival rate was 70.0%, which was significantly higher than 50.0% in the control group(P<0.05). Conclusion Glisson's pedicle occlusion has the advantages of less bleeding, shorter operation time, quicker recovery and fewer complications in the treatment of primary liver cancer, and can effectively improve liver function and improve survival rate. It is worthy of clinical promotion.
Objective To explore the effect of Glisson's pedicle occlusion on the curative effect and prognosis of patients with primary liver cancer, and to provide clinical guidance for the treatment of primary liver cancer.Methods The clinical data of 60 patients were retrospectively analyzed, who were hospitalized in the Second Department of General Surgery at the Second People's Hospital of Three Gorges University from January 2014 to January2015. According to different surgical methods, the patients were divided into observation group and control group, with30 cases in each group. The control group was treated with Pringle method for blocking the first hepatic portal operation,and the observation group was treated with Glisson pedicle blocking operation. The operation time, bleeding volume, intraoperative blood transfusion volume, hepatic blood flow occlusion, liver function related indicators, postoperative complications, and postoperative survival rate were compared between the two groups. Results The time of hepatic blood flow occlusion in the observation group was(31.5±8.9) min, which was not statistically significant compared with(29.8±8.2) min in the control group(P>0.05). The operation time and hospitalization time in the observation group were(82.6±3.4) min and(11.3±2.1) d, respectively, which were significantly shorter than corresponding(105.1±2.4) min and(15.2±2.5) d in the control group(P<0.05). The bleeding volume and intraoperative blood transfusion volume in the observation group were respectively(133.5 ± 24.4) mL,(197.3 ± 12.3) mL, which were significantly lower than corresponding(184.3±30.1) mL and(258.1±14.6) m L in the control group(P<0.05). After operation, alanine aminotransferase(ALT),aspartate aminotransferase(AST), total bilirubin(TBIL), and prothrombin time(PT) were significantly elevated in the two groups; and the ALT, AST, TBIL and PT in the observation group were significantly higher than those in the control group(P<0.05). The incidence of postoperative complications in the observation group was 6.7%, which was significantly lower than 13.3% in the control group; and the postoperative 3-year survival rate was 70.0%, which was significantly higher than 50.0% in the control group(P<0.05). Conclusion Glisson's pedicle occlusion has the advantages of less bleeding, shorter operation time, quicker recovery and fewer complications in the treatment of primary liver cancer, and can effectively improve liver function and improve survival rate. It is worthy of clinical promotion.
引文
[1]卢焕全,叶镇彭,黄兆伦,等.Glisson蒂横断式精准肝切除联合美蓝染色法在肝癌中的应用价值[J].中国医药科学,2015,5(20):128-130.
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[14]NAKAMURA S,NOUSO K,ONISHI H,et al.Prevention of vagotonia and pain during radiofrequency ablation of liver tumors[J].Hepatol Res,2014,44(13):1367-1370.
[15]王超,王磊,周阳.Glisson蒂横断法在腹腔镜左肝段切除术中的应用[J].腹腔镜外科杂志,2017,22(09):661-664.
[16]喻智勇,曾仲,段健,等.Glisson蒂横断式肝切除术10例报告[J].中国现代手术学杂志,2010,14(4):245-247.
[17]LI J,DAULT D,NAIR N,SHANKER B.Analysis of scattering from complex dielectric objects using the generalized method of moments[J].J Opt Soc Am A Opt Image Sci Vis,2014,31(11):2346-2355.
[18]吴宗杨,冯济业,王金波,等.Glisson蒂横断式肝切除术治疗肝癌的临床研究[J].肝胆胰外科杂志,2014,26(4):342-344.
[19]赵明海,朱少功,魏思东.肝门部Glisson蒂交替血流阻断循Glisson鞘行肝右前叶下段解剖性切除术[J].河南外科学杂志,2014,20(5):21-22.
[20]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
[2]祁付珍,许刚,宋研,等.Glisson蒂横断式肝切除在原发性肝癌中的应用[J].实用医学杂志,2016,32(1):65-68.
[3]赖良,张国平,谢飞,等.Glisson蒂阻断式肝切除术33例报道[J].中国医药指南,2016,14(18):16-17.
[4]高绪照,唐瑞,熊廷刚,等.Glisson蒂阻断在肝切除术的应用[J].肝胆外科杂志,2016,24(1):57-58.
[5]蒋辉,丁兵,张瑜.Pringle法肝切除与Glisson蒂横断式肝切除在原发性肝癌切除术中的应用及对比分析[J].吉林医学,2017,38(12):2259-2261.
[6]熊锐,尹涛,段传谊,等.Glisson蒂横断法原位扩大右后叶肝切除在原发性肝癌治疗中的临床应用[J].中国普通外科杂志,2018,27(01):121-124.
[7]SIGGERS JH,LEUNGCHAVAPHONGSE K,HO CH,et al.Mathematical model of blood and interstitial flow and lymph production in theliver[J].Biomech Model Mechanobiol,2014,13(2):363-378.
[8]方兆山,杨剑,庞珏,等.3D腹腔镜Glisson蒂横断式肝切除术治疗肝癌对机体细胞免疫功能的影响[J].实用医学杂志,2018,34(12):2004-2006+2011.
[9]周少波,艾克拜尔·尔肯,等.不同肝血流阻断技术在肝囊型包虫病外囊剥除术中的应用比较[J].中国普通外科杂志,2018,27(7):893-898.
[10]吴孟超,汤钊猷,刘彤华,等.原发性肝癌规范化病理诊断指南(2015年版)[J].临床肝胆病杂志,2015,31(06):833-839.
[11]祝普利,尹超,冯建龙.原发性肝癌综合治疗进展[J].临床肝胆病杂志,2015,31(6):965-968.
[12]谢飞,赖良,牟廷刚,等.Glisson蒂横断联合前入路绕肝提拉法在肝右叶巨大肝癌切除术中的应用[J].肝胆胰外科杂志,2015,27(4):269-272.
[13]贾长库,王石坚,陈有科,等.解剖性右肝三段切除治疗右肝巨大或多发性肝癌[J].中国普通外科杂志,2015,24(7):939-944.
[14]NAKAMURA S,NOUSO K,ONISHI H,et al.Prevention of vagotonia and pain during radiofrequency ablation of liver tumors[J].Hepatol Res,2014,44(13):1367-1370.
[15]王超,王磊,周阳.Glisson蒂横断法在腹腔镜左肝段切除术中的应用[J].腹腔镜外科杂志,2017,22(09):661-664.
[16]喻智勇,曾仲,段健,等.Glisson蒂横断式肝切除术10例报告[J].中国现代手术学杂志,2010,14(4):245-247.
[17]LI J,DAULT D,NAIR N,SHANKER B.Analysis of scattering from complex dielectric objects using the generalized method of moments[J].J Opt Soc Am A Opt Image Sci Vis,2014,31(11):2346-2355.
[18]吴宗杨,冯济业,王金波,等.Glisson蒂横断式肝切除术治疗肝癌的临床研究[J].肝胆胰外科杂志,2014,26(4):342-344.
[19]赵明海,朱少功,魏思东.肝门部Glisson蒂交替血流阻断循Glisson鞘行肝右前叶下段解剖性切除术[J].河南外科学杂志,2014,20(5):21-22.
[20]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