中国实用外科杂志

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原发性肝癌规则与非规则性肝切除术式探讨

冯志强1,肖    梅1,张洪义1黄志强2a徐立宁2b, 张    辉1,张宏义1甄玉英1   

  1. 1.中国人民解放军空军总医院肝胆外科,北京100142;2中国人民解放军总医院a.肝胆外科b.南楼临床部外二科,北京100853
  • 发布日期:2012-02-24

  • Published:2012-02-24

摘要:

目的    分析原发性肝癌规则性肝切除和非规则性肝切除的围手术期因素,探讨原发性肝癌治疗中二者手术适应证。方法    回顾性分析中国人民解放军空军总医院1990-2010年原发性肝癌中274例规则性肝切除术和586例非规则性肝切除术病人的临床资料。结果    统计分析表明,规则性肝切除与非规则性肝切除相比,对术前病人肝功能状态要求更加严格,术中切除肝体积以及出血量、输血量均较非规则性肝切除组显著增多,手术时间延长,术后并发症发生率增加。但实施规则性肝切除术病人的肿瘤体积明显大于非规则性肝切除病人,切除肝段数目大于三段者所占比例亦显著高于非规则性肝切除组。结论    对于<5cm的肝癌病人,采用非规则性肝切除保留更多功能性肝实质,可能更有利于病人术后恢复,减少相关并发症的发生。

关键词: 原发性肝癌, 肝切除术, 规则性切除, 非规则性切除, 围手术期

Abstract:

Clinical study of regular hepatectomy and irregular hepatectomy in primary liver cancer        FENG Zhi-qiang, XIAO Mei, ZHANG Hong-yi, et al.  Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing 100142, China
Corresponding author: ZHANG Hong-yi, E-mail:zhhyiyi1487@163.com
Abstract    Objective    To investigate surgical indication for primary liver cancer according to analyze operative and perioperative factors of regular hepatectomy and irregular hepatectomy. Methods    The operative and perioperative factors of 274 cases of regular hepatectomies and 586 cases of irregular hepatectomies in primary liver cancer performed from 1990 to 2010 at Chinese PLA Air Force General Hospital were investigated retrospectively according to their medical documentation. Results    Statistical analysis showed that the regular hepatectomy need a more stringent requirements in the liver function and more liver volume, blood loss, transfusion, moe operation time than the irregular hepatectomy. It also increased the rate of postoperative complications. But the tumor volume of regular hepatectomies was significantly greater than the irregular hepatectomies, and the proportion of three sections hepatectomy or more sections is significantly higher than the irregular hepatectomies. Conclusion    For tumors less than 5cm of liver cancer, irregular hepatectomy can retain more functional liver parenchyma. Maybe it is more conducive to the recovery of patients after the operation and reduce the associated complications.

Key words: primary liver cancer, hepatectomy, regular hepatectomy, irregular hepatectomy, perioperative period