论文部分内容阅读
目的评估半肝血流完全阻断法(THHVE)在肝细胞癌肝切除术中的应用价值及其对肿瘤复发、转移和患者生存期的影响。方法 2011年8月至2013年8月期间在我科住院拟行手术切除的肝癌患者中,选择符合标准的患者纳入本研究。将所有入选患者随机分为两组,THHVE组患者在肝切除术中采用THHVE法控制血流,Pringle组采用Pringle法控制血流。对两组患者的术中总出血量、断肝过程中出血量、输血率、手术时间、血流阻断时间、并发症发生率、死亡率、术后住院时间、术后肝功能指标、无瘤生存期和总生存期等进行比较。结果剔除不符合纳入标准的患者,共有143例符合标准的患者纳入最终分析,THHVE组71例,Pringle组72例。与Pringle组相比较,THHVE组患者的术中总出血量[250.0(150.0~400.0)mL vs 350.0(200.0~637.5)mL,P<0.001]及断肝过程中出血量[100.0(50.0~200.0)mL vs 215.0(100.0~380.0)mL,P<0.001]均减少。THHVE组患者的血流阻断时间长于Pringle组[27.0(20.0~31.0)min vs 20.0(16.0~24.0)min,P<0.001],术后第1、第3、第7天的丙氨酸氨基转移酶水平低于Pringle组(P<0.05),术后第7天的总胆红素水平低于Pringle组(P=0.013)、血清前白蛋白高于Pringle组(P=0.038)。THHVE组并发症发生率低于Pringle组(21.1%vs 37.5%,P=0.032)。THHVE组患者的总生存期长于Pringle组(P=0.036),Cox比例风险回归模型多因素分析结果显示采用THHVE法是影响患者总生存期的独立因素之一,采用THHVE法的患者的死亡风险是采用Pringle法的47.6%。结论THHVE法是肝癌肝切除术中一种安全、有效的血流控制方法,可减少术中出血、减轻术后肝功能损害、降低并发症发生率,较Pringle法明显延长了患者的总生存期。
Objective To evaluate the value of THHVE in hepatectomy of hepatocellular carcinoma (HCC) and its effect on tumor recurrence, metastasis and patient survival. Methods From August 2011 to August 2013 in our hospital admitted to undergo surgical resection of liver cancer patients, select the standard patients were included in this study. All selected patients were randomly divided into two groups. Patients in THHVE group underwent THHVE to control blood flow in hepatectomy. Pringle group used Pringle method to control blood flow. Total blood loss, blood loss, blood transfusion rate, operation time, blood flow blocking time, complication rate, mortality rate, postoperative hospital stay, postoperative liver function index, Tumor survival and overall survival were compared. Out of patients who did not meet the inclusion criteria, 143 eligible patients were included in the final analysis, 71 in the THHVE group and 72 in the Pringle group. Compared with the Pringle group, the total intraoperative blood loss [250.0 (150.0-400.0) mL vs 350.0 (200.0-637.5) mL, P <0.001] and the amount of bleeding in the process of hepatic failure [100.0 (50.0-200.0) mL vs 215.0 (100.0 ~ 380.0) mL, P <0.001]. The time of blood flow blocking in THHVE group was longer than that in Pringle group [27.0 (20.0-31.0) min vs 20.0 (16.0-24.0) min, P <0.001], and the alanine amino groups on the 1st, 3rd, The level of total bilirubin in the seventh day after operation was lower than that in the Pringle group (P = 0.013), and the level of serum prealbumin was higher than that in the Pringle group (P = 0.038). The incidence of complications in the THHVE group was lower than in the Pringle group (21.1% vs 37.5%, P = 0.032). The overall survival of patients in THHVE group was longer than that in Pringle group (P = 0.036). Multivariate analysis of Cox proportional hazards regression model showed that THHVE was one of the independent factors affecting the overall survival of patients. The risk of death in THHVE patients was 47.6% using the Pringle method. Conclusion The THHVE method is a safe and effective method of blood flow control in hepatectomy of liver cancer, which can reduce intraoperative bleeding, reduce postoperative liver damage and reduce the incidence of complications. Compared with Pringle method, the THHVE method significantly prolongs the overall survival of patients .