摘要
目的 总结原发性肝癌手术切除病例的治疗效果。方法 回顾性分析近 5年我院 30 1例肝癌病人手术切除治疗情况。结果 4 0 %有乙肝病史 ,6 2 %伴有肝炎。肝功能A级 4 6 % ,B级38% ,C级 16 %。肿瘤位于左肝占 31% ,右肝 6 5 % ,左右肝 4 %。小肝癌 2 3% ,大肝癌 76 %。 6 1%合并肝硬化 ,8%合并门静脉癌栓 ,3%合并胆管癌栓。左外叶切除 8 6 % ,左半肝切除 8% ,右半肝切除12 6 % ,肝段切除 71 8%。 31%采用Pringle术 ,阻断时间为 15± 4min ,最长 30min。 10 %采用半肝血流阻断术 ,阻断时间为 2 5± 12min ,最长 6 0min。 1 3%采用全肝血流阻断术 (改良Heaney法 ) ,阻断时间为 14± 4min ,最长者为 2 0min。术中出血量为 10 5 6± 1195ml,输血量为 6 6 5± 5 91ml,手术时间为 194± 84min。术后总并发症发生率为 19 9% ,严重并发症发生率为 7 3% ,手术死亡率为2 7% ,住院时间为 2 5± 12d。术后 1,3,5年存活率分别为 74 % ,5 6 % ,4 2 %。结论 肝切除术后并发症发生率较高 ,但严重并发症发生率和手术死亡率较低。术中控制出血及肝切除量 。
Objective To investigate the effect of hepatectomy in treatment of hepatocellular carcinoma (HCC). Methods The clinical data of 301 HCC patients received hepatectomy in our hospital in recent 5 years were retrospectively analyzed. Results Upon admission, 40% of the patients had the history of hepatitis B and 62% were complicated with hepatitis B. Liver function grade A was found in 46%, B in 38% and C in 16%. Tumors were found to locate in the left lobe in 31%, right lobe in 65% and bilateral lobes in 4%. Small HCC was found in 23% while major HCC in 76%. Of all the patients, 61% were complicated with liver cirrhosis, 8% with portal vein thrombi and 3% with biliary thrombi. Left lateral lobectomy was performed in 8 6%, left half lobectomy in 8%, right half lobectomy in 12 6% and segmentectomy in 71 8%. Pringle procedure was employed in 31%, semi liver blood occlusion in 10% and modified Heaney procedure in 1 3%. Perioperative blood loss was 1 056±1 195 ml with 665±591 ml of blood infusion. The mean operative duration was 194±84 minutes, hospital stay 25±12 days. After the operation, 1 , 3 and 5 year survival rates were 74%, 56% and 42%, respectively. Conclusions Though hepatectomy for HCC may result in a relatively high overall morbidity, its incidence of severe complications and operative mortality are significantly low. Decreasing blood loss, controlling the volume for hepatectomy and reducing operative duration are crucial for decreasing the morbidity and mortality.
出处
《中华肝胆外科杂志》
CAS
CSCD
2002年第7期411-413,共3页
Chinese Journal of Hepatobiliary Surgery
关键词
原发性肝癌
外科手术
肝切除术
治疗
Carcinoma hepatocellular
Surgical operation
Hepatectomy
