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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2015, Vol. 09 ›› Issue (04) : 286 -290. doi: 10.3877/cma.j.issn.1674-0793.2015.04.007

所属专题： 文献；

论著

不解剖肝门的半肝与全肝入肝血流阻断在肝细胞癌患者行肝切除术中的临床应用比较
林建宇1, 陈永标1, 吕立志1, 江艺1,†()   
  1. 1. 350025　福州，解放军南京军区福州总医院肝胆外科
  • 收稿日期:2015-02-28 出版日期:2015-08-01
  • 通信作者: 江艺
  • 基金资助:
    福建省科技重点项目(2014Y0034)

Comparison of half and total vascular inflow occlusion without hilus dissection in hepatocellular carcinoma patients undergoing hepatectomy

Jianyu Lin1, Yongbiao Chen1, Lizhi Lyu1, Yi Jiang1,†()   

  1. 1. Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Fuzhou 350025, China
  • Received:2015-02-28 Published:2015-08-01
  • Corresponding author: Yi Jiang
  • About author:
    Corresponding author: Jiang Yi, Email:
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引用本文：

林建宇, 陈永标, 吕立志, 江艺. 不解剖肝门的半肝与全肝入肝血流阻断在肝细胞癌患者行肝切除术中的临床应用比较[J]. 中华普通外科学文献(电子版), 2015, 09(04): 286-290.

Jianyu Lin, Yongbiao Chen, Lizhi Lyu, Yi Jiang. Comparison of half and total vascular inflow occlusion without hilus dissection in hepatocellular carcinoma patients undergoing hepatectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(04): 286-290.

目的

探讨不解剖肝门的半肝入肝血流阻断(HIO)与全肝入肝血流阻断(TIO)在肝细胞癌患者行肝切除术中的临床应用效果。

方法

回顾性分析肝细胞癌行肝切除术患者63例,并随机分为两组,HIO组(33例)行不解剖肝门的半肝入肝血流阻断联合控制性低中心静脉压肝切除,TIO组(30例)行全肝入肝血流阻断联合控制性低中心静脉压肝切除。比较两组手术时间、血流阻断时间、术中出血量、术中输血情况,以及术后住院时间、ICU时间、术后第1、3天肝功能。

结果

两组手术时间、血流阻断时间、术后ICU时间、术中出血量、术中输血情况差异无统计学意义, HIO组术后住院时间显著短于TIO组[(14.1±5.5) d vs (17.2±5.8)d,t=-2.142,P=0.036];术后第1天HIO组患者血清白蛋白(Alb)水平显著高于TIO组[(34.2±3.5)g/L vs (31.6±3.8)g/L,t=2.784,P=0.007],其余肝功指标(ALT、AST、AKP、GGT、TB、DB)在术后第1天的水平差异无统计学意义,术后第3天两组间肝功指标水平差异无统计学意义。

结论

两种肝血流阻断技术同样安全、有效,半肝入肝血流阻断在术后住院时间及早期Alb水平恢复上更优。

关键词: 肝细胞癌, 肝切除术, 半肝入肝血流阻断, 全肝入肝血流阻断
Objective

To compare the efficacy of half versus total vascular inflow occlusion without hilus dissection in hepatocellular carcinoma (HCC) patients undergoing hepatectomy.

Methods

Sixty-three HCC patients undergoing hepatectomy were divided into two groups: half vascular inflow occlusion group (HIO) and total vascular inflow occlusion group (TIO). There were no hilus dissection and combined controlled low central venous pressure in both groups. Operation time, occlusion time, postoperative hospital stay, postoperative ICU stay, blood loss and transfusion during operation and postoperative day 1 and day 3 liver functions were compared.

Results

Operation time, occlusion time, postoperative ICU stay, blood loss and transfusion during operation had no significant differences between two groups. Postoperative hospital stay was significantly shorter in HIO group [(14.1±5.5) d vs (17.2±5.8) d, t=-2.142, P=0.036]. Postoperative day 1 serum albumin level was significantly higher in HIO group [(34.2±3.5) g/L vs (31.6±3.8) g/L, t=2.784, P=0.007], while levels of ALT, AST, AKP, GGT, TB, DB had no significant differences between two groups. Postoperative day 3 liver functions had no significant differences between two groups.

Conclusion

Both occlusion methods are safe and effective, while half vascular inflow occlusion leads to shorter postoperative hospital stay and higher serum albumin level the first day after operation.

Key words: Hepatocellular carcinoma, Hepatectomy, Half vascular inflow occlusion, Total vascular inflow occlusion
表1 两组患者基本资料比较
项目 HIO组 TIO组 统计值 P值
例数 33 30 ? ?
年龄(岁,±s) 49.9±10.9 53.2±10.2 -1.234 0.222
性别(例) ? ? 2.438 0.118
? 男 25 28 ? ?
? 女 8 2 ? ?
术前Child-Pugh分级(例) ? ? 0.000 1.000
? A 32 29 ? ?
? B 1 1 ? ?
肿瘤部位(例) ? ? 0.164 0.686
? 肝右叶 25 24 ? ?
? 肝左叶 8 6 ? ?
肿瘤数目(例) ? ? 0.379 0.538
? 单发 32 27 ? ?
? 多发 1 3 ? ?
是否有大血管侵犯(例) ? ? 0.000 1.000
? 是 2 2 ? ?
? 否 31 28 ? ?
肿瘤直径(cm,±s) 5.5±4.3 6.4±4.2 -0.183 0.419
ALT(U/L,±s) 40.7±33.9 35.1±15.7 0.791 0.432
AST(U/L,±s) 45.0±24.3 52.2±31.0 -1.031 0.307
AKP(U/L,±s) 87.5±36.7 105.6±72.1 -1.271 0.208
GGT(U/L,±s) 70.1±63.1 113.8±167.8 -1.342 0.188
TB(μmol/L,±s) 15.4±6.5 13.5±6.6 1.182 0.242
DB(μmol/L,±s) 4.5±2.4 4.0±1.7 0.767 0.134
Alb(g/L,±s) 40.9±4.5 39.2±3.5 1.708 0.093
手术方式(例) ? ? 1.310 0.519
? 局部切除 23 21 ? ?
? 肝段切除 8 5 ? ?
? 半肝切除 2 4 ? ?
表2 两组手术时间、血流阻断时间、术后住院时间、术后ICU时间(±s, t检验)
组别 手术时间(min) 血流阻断时间(min) 术后住院时间(d) 术后ICU时间(d)
HIO组 140.7±37.4 21.4±8.0 14.1±5.5 2.4±1.6
TIO组 145.5±74.0 19.0±8.7 17.2±5.8 2.8±1.4
t值 -0.327 1.108 -2.142 -1.047
P值 0.745 0.272 0.036 0.299
表3 两组术后第1天肝功能指标比较(±s, t检验)
组别 ALT(U/L) AST(U/L) AKP(U/L) GGT(U/L) TB(μmol/L) DB(μmol/L) Alb(g/L)
HIO组 486.6±359.6 565.9±435.7 99.7±42.5 60.6±54.2 23.5±12.7 6.6±5.2 34.2±3.5
TIO组 477.3±299.5 569.7±318.6 98.1±41.0 66.1±56.4 20.2±8.1 6.3±3.0 31.6±3.8
t值 0.112 -0.039 0.155 -0.396 1.183 0.333 2.784
P值 0.911 0.969 0.878 0.693 0.241 0.740 0.007a
表4 两组术后第3天肝功能指标比较(±s, t检验)
组别 ALT(U/L) AST(U/L) AKP(U/L) GGT(U/L) TB(μmol/L) DB(μmol/L) Alb(g/L)
HIO组 228.3±128.2 100.7±23.3 101.5±18.7 68.0±38.1 19.0±6.7 5.8±3.1 28.1±2.9
TIO组 233.2±101.0 102.5±34.2 102.9±22.1 65.0±25.4 18.6±4.5 5.9±2.1 28.5±2.8
t值 -0.166 -0.251 -0.269 0.368 0.235 -0.117 -0.605
P值 0.869 0.803 0.789 0.714 0.815 0.907 0.547
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