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《解剖性和非解剖性肝切除对肝细胞癌患者预后的影响.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、临床外科杂志2014年9月第22卷第9期JClinSurg,Seotember2014,Vo1.22,No.9·669··论著·解剖性和非解剖性肝切除对肝细胞癌患者预后的影响李予闽[摘要】目的探讨解剖性肝切除和非解剖性肝切除对肝细胞癌患者预后的影响。方法62例肝细胞癌患者,其中33例采用解剖性肝切除术进行治疗(AH组),29例采用非解剖性肝切除术进行治疗(IH组);记录手术情况和血红蛋白(Hb)损失量。术后采取患者空腹静脉血,检测肝细胞癌AFPmRNA表达;并记录复发率、死亡率及并发症情况。结果AH组的平均手术时间显著高于IH组,但术中出血量和手术Hb损
2、失量显著低于IH组(P<0.05);两组患者的AFPmRNA表达水平和术后复发率差异无统计学意义(P>0.05),AH组的近期死亡率稍低于IH组(P<0.05),但远期死亡率与IH组相仿(P>0.05);在并发症方面,总发生率差异无统计学意义(P>0.05),但AH组以肝功能障碍为主,多发于肝硬化或肝纤维化患者,IH组以腹腔内出血和感染为主,多发生于中心性肿瘤患者。结论解剖性切除术能够有效保护肝细胞癌血管,可改善患者预后,但对于肝脏存在严重病理性损伤患者,存在一定风险,可考虑非解剖性切除术。[关键词]解剖性肝切除;非解剖性肝切除;肝细胞癌;预后[中图分类
3、号]R657.3;R735.7[文献标识码]A[DOI]10.3969/j.issn.1005-6483.2014.09.018EFectsofanatomicalandnonanatomicalhepatectomyOntheprognosisofpatientswithHCCYu—min.(DepartmentofGeneralSurgery,theFintPeopleHospitalofLuoyang,Itenan471002,China)lAbstractslobjectiveToexploretheeffectsofanatomicalandn
4、onanatomicalhepatectomyontheprognosisofpatientswithhepatocellularcarcinoma(HCC.MethodsAtotalof62HCCpatientswereenrolled,including33casesofanatomicalhepatectomy(GroupAH)and29casesofnonanatomicalhepa—tectomy(GroupIH).Theoperationsituationandhematocrystallin(HB)losswererecord.Fastin
5、gvenousbloodofHCCpatientswereextractedfordetectionofcirculatingAFPmRNAexpression.Therecurrence.mortalityandcomplicationratewererecordedatthesanletime.ResultsTheoperativetimeofGroupAHwassignificantlyhigherthanthatofGroupIH,whilethebleedingvolumeandHBlosswerelower(P<0.051.Therewere
6、nosignificantdiferencesinAFPmRNAexpressionandrecurencerate.Theshort—termmortalityrateofGroupAHwaslowerthanGroupIH(P<0.05)。buttheirlong.termmortalityratesweresimilar(P>0.05).Therewasnosignificantdifferenceincomplicationratebetweengroups.PatientsofGroupAHgotmorehepatosisduetoliverc
7、irhosisorfibrosis.whilepatientsofGroupIHgotmorebleedingorinfectionduetothecentraltumor.ConclusionAnatomiealhepatectomyhasadvantagesiflprotectingarteryandimprovingprognosisforHCCpatients,butithassurgicalrisksforpatientswithseriouspatholog—icaldamageinhepaticlobes.andnonanatomicalh
8、epatectomymaybeconsidered.[Keywords]anat
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