不同肝血流阻断方案对手术切除原发性大肝癌患者治疗效果比较
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摘要
目的探讨不同肝血流阻断方法对外科手术切除原发性大肝癌患者疗效的影响。方法 2014年5月~2016年5月收治的172例原发性大肝癌患者,分别采用肝门阻断(n=52)、半肝阻断(n=44)和联合阻断(n=76)血流行肝癌切除术。结果三组患者的基本资料比较差异无统计学意义(P>0.05);三组血流阻断时间、手术用时和切除肝量差异均无统计学意义(P>0.05),肝门阻断组出血量为(736.38±498.36)ml,显著多于半肝阻断组[(472.56±111.89)ml或联合阻断组的(356.14±132.53)ml,P<0.05],肝门阻断组输血量为(586.54±132.58)ml,显著多于半肝阻断组[(427.95±210.47)ml或联合阻断组的(184.38±72.54)ml,P<0.05];术后7 d,肝门阻断组血清ALT水平为(73.02±43.41)U/L,显著高于半肝阻断组[(55.89±40.82)U/L或联合阻断组的(52.01±33.81)U/L,P<0.05];三组手术并发症以肺部感染、切口感染、胆瘘、腹腔积液为主,但其发生率差异无统计学意义(P>0.05);联合阻断组1 a生存率为96.1%,肿瘤复发率为2.6%,显著低于肝门阻断组的75.0%和15.4%或半肝阻断组的68.2%和20.5%(P<0.05)。结论 Pringle法联合肝下腔静脉阻断术阻断血流在切除原发性大肝癌患者外科手术过程中可以有效降低术中出血量,促进患者术后恢复,或许还能提高生存率。
Objective To investigate the efficacy of different hepatic inflow occlusion in hepatectomy in treatment of patients with primary large liver cancer. Method 172 patients with primary large liver cancer in our hospital and in Second Hospital affiliated to Dalian Medical University between May 2014 and May 2016 were divided into three groups according to the different methods of blood flow occlusion during hepatectomy. 52 cases received portal occlusion,44 cases received hemihepatic occlusion,and 76 cases received combination occlusion.The relevant clinical parameters among the three groups were compared. R esults There was no significant differences in baseline data among the three groups(P >0.05);there was no significant differences in blocking time,operation time and hepatic resection volumes among the three groups(P>0.05);the amounts of bleeding in portal occlusion group was(736.38 ±498.36) ml,much more excessive than [(472.56 ±111.89) ml in hemihepatic occlusion group or(356.14 ±132.53) ml in combination occlusion group,P <0.05],and the blood transfusion volumes in portal occlusion group was(586.54 ±132.58)ml,much more massive than [(427.95 ±210.47) ml in hemihepatic occlusion group or(184.38±72.54) ml in combination occlusion group,P<0.05];7 days after operations,serum ALT level in portal occlusion group was(73.02 ±43.41)U/L,much higher than [(55.89 ±40.82) U/L in hemihepatic occlusion group,or(52.01 ±33.81) U/L in combination occlusion group(P <0.05);there was no significant differences as respect to complication rate among the three groups(P >0.05);the 1 a survival rate in combination group was 96.1% and the tumor relapse rate was 2.6%,much lower than 75.0% and 15.4% in portal occlusion group or 68.2% and 20.5%,respectively,in hemihepatic occlusion group(P <0.05). Conclusion The application of Pringle method combined with inferior vena cava occlusion in blocking hepatic blood flow during hepatectomy in treatment of patients with primary large liver cancer can effectively reduce the amount of intraoperative bleeding,improve recovery,and might increase survivals.
Objective To investigate the efficacy of different hepatic inflow occlusion in hepatectomy in treatment of patients with primary large liver cancer. Method 172 patients with primary large liver cancer in our hospital and in Second Hospital affiliated to Dalian Medical University between May 2014 and May 2016 were divided into three groups according to the different methods of blood flow occlusion during hepatectomy. 52 cases received portal occlusion,44 cases received hemihepatic occlusion,and 76 cases received combination occlusion.The relevant clinical parameters among the three groups were compared. R esults There was no significant differences in baseline data among the three groups(P >0.05);there was no significant differences in blocking time,operation time and hepatic resection volumes among the three groups(P>0.05);the amounts of bleeding in portal occlusion group was(736.38 ±498.36) ml,much more excessive than [(472.56 ±111.89) ml in hemihepatic occlusion group or(356.14 ±132.53) ml in combination occlusion group,P <0.05],and the blood transfusion volumes in portal occlusion group was(586.54 ±132.58)ml,much more massive than [(427.95 ±210.47) ml in hemihepatic occlusion group or(184.38±72.54) ml in combination occlusion group,P<0.05];7 days after operations,serum ALT level in portal occlusion group was(73.02 ±43.41)U/L,much higher than [(55.89 ±40.82) U/L in hemihepatic occlusion group,or(52.01 ±33.81) U/L in combination occlusion group(P <0.05);there was no significant differences as respect to complication rate among the three groups(P >0.05);the 1 a survival rate in combination group was 96.1% and the tumor relapse rate was 2.6%,much lower than 75.0% and 15.4% in portal occlusion group or 68.2% and 20.5%,respectively,in hemihepatic occlusion group(P <0.05). Conclusion The application of Pringle method combined with inferior vena cava occlusion in blocking hepatic blood flow during hepatectomy in treatment of patients with primary large liver cancer can effectively reduce the amount of intraoperative bleeding,improve recovery,and might increase survivals.
引文
[1]陈万青,郑荣寿,曾红梅,等.2011年中国恶性肿瘤发病和死亡分析.中国肿瘤,2015,24(1):2-10.
[2]黎福良,车斯尧,黄思敏,等.半肝血流阻断在肝癌半肝切除中的临床研究.肝胆胰外科杂志,2015,27(5):424-426.
[3]庞军,陈浩涛,陈燕,等.立体定向放射治疗联合中药治疗原发性大肝癌的临床研究.中国癌症防治杂志,2012,4(2):158-162.
[4]Tong Y,Yang JM,Lai EC,et al.Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection:a comparative study.Hepatogastroenterology,2011,58(109):1307-1311.
[5]吴健雄,余微波.中央型肝癌治疗理念的开拓与创新.肝胆胰外科杂志,2013,25(3):177-181.
[6]鹿存芝,李向阳.甲胎蛋白联合CA199、AFU及CEA在原发性肝癌中的诊断价值.检验医学与临床,2017,14(10):1412-1414.
[7]芦东徽,钱立庭,费振乐,等.41例巨大原发性肝癌三维适形放射治疗临床观察.实用肝脏病杂志,2013,16(3):245-247.
[8]张彤,赵德芳,赵利军.Pringle肝血流阻断和半肝血流阻断在肝癌切除术中的应用比较.中华临床医师杂志(电子版),2013,7(17):8008-8010.
[9]杨慧林,梅礼强.不同肝血流阻断方式在肝癌合并肝硬化患者肝切除术中的效果比较.中国医药导报,2015,12(7):78-81.
[10]戴亚新,张时亮,裴豪.肝癌和肝病患者血清甲胎蛋白异质体的检测及临床意义.中国实验诊断学,2013,17(2):296-298.
[11]甄茂川,刘平果,王效民,等.不同入肝血流阻断在原发性肝癌切除术中的应用.中国医学创新,2014,11(36):4-6.
[12]刘允怡,赖俊雄,刘晓欣.肝血流阻断技术在肝切除中的应用.中国实用外科杂志,2010,30(8):625-626.
[13]李连海.不同血流阻断法在原发性肝癌手术中的效果分析.中国实用医药,2016,11(3):64-65.
[14]张涛,李明皓.原发性肝癌切除术中选择性半入肝血流阻断法与Pringle法的应用研究.宁夏医科大学学报,2012,34(5):489-491.
[15]金山,戴朝六.三种肝血流阻断法对大鼠肝脏缺血再灌注后肝细胞凋亡的影响.实用肝脏病杂志,2010,13(5):331-333.
[16]李清汉,甄作均,陈应军,等.经肝门板半肝阻断在肝细胞肝癌切除术中的应用研究.中华肝脏外科手术学电子杂志,2012,1(3):157-161.
[17]周存才,杨小敏,周新文,等.陈氏简易全肝血流阻断技术的临床应用:附280例报道.中国普通外科杂志,2014,23(1):6-12.
[18]柯延壮,侯本新,刘松平,等.两种肝门阻断切除术式对巨大肝癌患者健侧肝组织功能的影响.河北医学,2015,21(10):1594-1597.
[19]Dou L,Meng WS,Su BD,et al.Step-by-step vascular control for extracapsular resection of complex giant liver hemangioma involving the inferior vena cava.Am Surg,2014,80(1):15-20.
[20]刘剑鸣,吕品,王俊,等.区域性肝血流阻断在肝癌切除术中的应用与近期效果.现代肿瘤医学,2016,24(7):1095-1099.
[2]黎福良,车斯尧,黄思敏,等.半肝血流阻断在肝癌半肝切除中的临床研究.肝胆胰外科杂志,2015,27(5):424-426.
[3]庞军,陈浩涛,陈燕,等.立体定向放射治疗联合中药治疗原发性大肝癌的临床研究.中国癌症防治杂志,2012,4(2):158-162.
[4]Tong Y,Yang JM,Lai EC,et al.Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection:a comparative study.Hepatogastroenterology,2011,58(109):1307-1311.
[5]吴健雄,余微波.中央型肝癌治疗理念的开拓与创新.肝胆胰外科杂志,2013,25(3):177-181.
[6]鹿存芝,李向阳.甲胎蛋白联合CA199、AFU及CEA在原发性肝癌中的诊断价值.检验医学与临床,2017,14(10):1412-1414.
[7]芦东徽,钱立庭,费振乐,等.41例巨大原发性肝癌三维适形放射治疗临床观察.实用肝脏病杂志,2013,16(3):245-247.
[8]张彤,赵德芳,赵利军.Pringle肝血流阻断和半肝血流阻断在肝癌切除术中的应用比较.中华临床医师杂志(电子版),2013,7(17):8008-8010.
[9]杨慧林,梅礼强.不同肝血流阻断方式在肝癌合并肝硬化患者肝切除术中的效果比较.中国医药导报,2015,12(7):78-81.
[10]戴亚新,张时亮,裴豪.肝癌和肝病患者血清甲胎蛋白异质体的检测及临床意义.中国实验诊断学,2013,17(2):296-298.
[11]甄茂川,刘平果,王效民,等.不同入肝血流阻断在原发性肝癌切除术中的应用.中国医学创新,2014,11(36):4-6.
[12]刘允怡,赖俊雄,刘晓欣.肝血流阻断技术在肝切除中的应用.中国实用外科杂志,2010,30(8):625-626.
[13]李连海.不同血流阻断法在原发性肝癌手术中的效果分析.中国实用医药,2016,11(3):64-65.
[14]张涛,李明皓.原发性肝癌切除术中选择性半入肝血流阻断法与Pringle法的应用研究.宁夏医科大学学报,2012,34(5):489-491.
[15]金山,戴朝六.三种肝血流阻断法对大鼠肝脏缺血再灌注后肝细胞凋亡的影响.实用肝脏病杂志,2010,13(5):331-333.
[16]李清汉,甄作均,陈应军,等.经肝门板半肝阻断在肝细胞肝癌切除术中的应用研究.中华肝脏外科手术学电子杂志,2012,1(3):157-161.
[17]周存才,杨小敏,周新文,等.陈氏简易全肝血流阻断技术的临床应用:附280例报道.中国普通外科杂志,2014,23(1):6-12.
[18]柯延壮,侯本新,刘松平,等.两种肝门阻断切除术式对巨大肝癌患者健侧肝组织功能的影响.河北医学,2015,21(10):1594-1597.
[19]Dou L,Meng WS,Su BD,et al.Step-by-step vascular control for extracapsular resection of complex giant liver hemangioma involving the inferior vena cava.Am Surg,2014,80(1):15-20.
[20]刘剑鸣,吕品,王俊,等.区域性肝血流阻断在肝癌切除术中的应用与近期效果.现代肿瘤医学,2016,24(7):1095-1099.