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目的 :比较B型超声引导下肝段染色指导肝切除术结合术中肝段门静脉阻断灌注化学药物治疗与一般肝切除术加术后TACE的疗效。方法 :应用B型超声引导下肝段染色指导肝切除术结合术中肝段门静脉阻断灌注化疗治疗 2 1例肝癌患者 (A组 ) ,应用一般肝切除术治疗 2 6例肝癌患者 (B组 ) ,应用一般肝切除术 +术后TACE治疗 17例肝癌患者 (C组 ) ,术后定期复查周围静脉血AFP ,CT及MRI变化 ,并随访 2年。结果 :A组较C组对患者肝功能影响小。A组的术后平均无癌生存时间为 2 1个月 ,B组的术后平均无癌生存时间为 11个月 ,C组的术后平均无癌生存时间为 19个月。A组术后 2年内有 4例患者出现肝内复发 ,B组术后 2年内有 16例患者出现肝内复发 ,C组术后 2年内有 4例患者出现肝内复发。结论 :B型超声引导下肝段染色指导肝切除术结合术中肝段门静脉阻断灌注化疗的中期疗效优于一般肝切除术 ,B型超声引导下肝段染色指导肝切除术结合术中肝段门静脉阻断灌注化疗的中期疗效与一般肝切除术加术后TACE相当 ,但前者对肝功能的损害少于后者。
OBJECTIVE: To compare the efficacy of B-mode ultrasound guided hepatic segmentectomy with intraoperative hepatic portal vein occlusion chemotheraphy and general hepatectomy plus postoperative TACE. Methods: Twenty-one patients with hepatocellular carcinoma (group A) underwent liver biopsy under the guidance of B-mode ultrasound guided hepatectomy combined with intraoperative hepatic portal vein occlusion perfusion chemotherapy, and 26 patients with hepatocellular carcinoma (group B) underwent general hepatectomy ). Seventeen patients with hepatocellular carcinoma (C group) underwent hepatectomy and TACE after operation. The changes of AFP, CT and MRI in peripheral venous blood were reviewed regularly and followed up for 2 years. Results: A group had less effect on liver function than C group. The average postoperative cancer free survival time in group A was 21 months. The average postoperative cancer free survival time in group B was 11 months. The average postoperative cancer free survival time in group C was 19 months. Intrahepatic recurrence occurred in 4 patients within 2 years after operation in group A, and intrahepatic recurrence occurred in 16 patients in group B within 2 years after operation. In group C, intrahepatic recurrence occurred in 4 patients within 2 years after operation. Conclusion: B-mode ultrasound-guided segmental hepatic segmentectomy combined with intraoperative hepatic portal vein occlusion perfusion chemotherapy is superior to the general effect of hepatectomy, B-guided ultrasound-guided segmental hepatectomy combined with intrahepatic liver The mid-term curative effect of portal vein occlusion perfusion chemotherapy is similar to that of general hepatectomy and postoperative TACE, but the former has less damage to liver function than the latter.