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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (01) : 16 -20. doi: 10.3877/cma.j.issn.2095-3232.2016.01.005

所属专题： 文献；

临床研究

前入路肝切除术在原发性肝癌手术中的应用价值
苏正1, 刘波2, 刘建平3,†(), 张华耀3, 杨尚霖3, 刘高杰4   
  1. 1. 510120　广州，中山大学孙逸仙纪念医院综合科
    2. 510530　广州，中山大学附属第三医院岭南医院普通外科
    3. 510120　广州，中山大学孙逸仙纪念医院肝胆外科
    4. 510120　广州，中山大学孙逸仙纪念医院胃肠外科
  • 收稿日期:2015-12-20 出版日期:2016-02-10
  • 通信作者: 刘建平
  • 基金资助:
    广州市2015年产学研专项(1561000198)

Application value of hepatectomy via anterior approach in surgery of primary liver cancer

Zheng Su1, Bo Liu2, Jianping Liu3,†(), Huayao Zhang3, Shanglin Yang3, Gaojie Liu4   

  1. 1. Comprehensive Department, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
    2. Department of General Surgery, Lingnan Branch, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
    3. Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
    4. Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
  • Received:2015-12-20 Published:2016-02-10
  • Corresponding author: Jianping Liu
  • About author:
    Corresponding author: Liu Jianping, Email:
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引用本文：

苏正, 刘波, 刘建平, 张华耀, 杨尚霖, 刘高杰. 前入路肝切除术在原发性肝癌手术中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2016, 05(01): 16-20.

Zheng Su, Bo Liu, Jianping Liu, Huayao Zhang, Shanglin Yang, Gaojie Liu. Application value of hepatectomy via anterior approach in surgery of primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(01): 16-20.

目的

探讨前入路肝切除术在原发性肝癌（肝癌）手术中的应用价值。

方法

回顾性分析2011年6月至2014年6月中山大学孙逸仙纪念医院和中山大学附属第三医院岭南医院收治138例行肝癌肝切除患者临床资料。其中男97例，女41例；年龄36～87岁，中位年龄52岁。所有患者均签署知情同意书，符合医学伦理学规定。根据不同手术方式将患者分为前入路肝切除组（前入路组，63例）和传统入路肝切除组（传统组，75例）。两组患者术前一般资料及术中、术后各项指标比较采用t检验或χ2检验。

结果

前入路组肝功能Child-Pugh分级B、C级、多发肿瘤、肿瘤直径>10 cm患者分别占73%（46/63）、44%（28/63）、16%（16/63），明显高于传统组的37%（28/75）、17%（13/75）、5%（4/75） （χ2=20.444，12.051，8.144；P<0.05）。前入路组平均术中出血量、输血浆量、输红细胞量分别为（428±17）、（470±14）、（300±7）ml，明显低于传统组的（517±11）、（630±15）、（420±11）ml（t=-6.097，-2.927，-8.928；P<0.05）；前入路组切除术后并发症发生率10%（6/63）明显低于传统组的17%（13/75） （χ2=1.759，P<0.05）。

结论

对于肝功能较差、肿瘤多发以及肿瘤巨大的患者，前入路肝切除术优于传统入路肝切除术，可作为此类患者优先选择的术式。

关键词: 前入路, 传统入路, 肝肿瘤, 肝切除术
Objective

To investigate the application value of hepatectomy via anterior approach in the surgery of primary liver cancer.

Methods

Clinical data of 138 patients with primary liver cancer undergoing hepatectomy in Sun Yat-sen Memorial Hospital and Lingnan Branch, the Third Affiliated Hospital of Sun Yat-sen University from June 2011 to June 2014 were retrospectively analyzed. There were 97 males and 41 females, aged 36 to 87 years with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into the anterior approach hepatectomy group (anterior group, n=63) and traditional approach hepatectomy group (traditional group, n=75). Preoperative general data, intra-, post-operative parameters of two groups were compared using t test or Chi-square test.

Results

In the anterior group, the percentage of patients with Child-Pugh liver function grade B and C, multiple tumors and tumor diameter > 10 cm was 73% (46/63), 44% (28/63) and 16%(16/63) respectively, which were significantly higher compared with 37% (28/75), 17% (13/75) and 5%(4/75) in the traditional group (χ2=20.444, 12.051, 8.144; P<0.05). In the anterior group, the average intraoperative blood loss, transfusion volume of plasma and red blood cells were (428±17), (470±14) and (300±7) ml, which were significantly lower compared with (517±11), (630±15) and (420±11) ml in the traditional group (t=-6.097, -2.927, -8.928; P<0.05). The rate of postoperative complications in anterior group was 10% (6/63), which was significantly lower compared with 17% (13/75) in the traditional group (χ2=1.759, P<0.05).

Conclusion

For patients with poor liver function, multiple and large tumors, hepatectomy via anterior approach is a preferential surgical procedure rather than the traditional approach hepatectomy.

Key words: Anterior approach, Traditional approach, Liver neoplasms, Hepatectomy
表1 前入路与传统入路肝癌肝切除患者术前一般资料比较（例）
组别 例数 性别 腹部手术史 乙肝病史
男 女 无 有 无 有
前入路组 63 46 17 49 14 24 39
传统入路组 75 51 24 57 18 21 54
χ2值 ? 0.412 0.061 1.588
P值 ? >0.05 >0.05 >0.05
组别 例数 肝功能Child-Pugh分级 肿瘤数目 肿瘤直径（cm）
A级 B级 C级 单发 多发 ≤10 >10
前入路组 63 17 27 19 35 28 53 10
传统入路组 75 47 22 6 62 13 71 4
χ2值 ? 20.444 12.051 8.144
P值 ? <0.05 <0.05 <0.05
表2 前入路与传统入路肝癌肝切除患者术中及术后各项指标比较（）
组别 例数 术中出血量（ml） 输血浆量（ml） 输红细胞量（ml） 手术时间（min） 住院时间（d）
前入路组 ? 428±17 470±14 300±7 237±12 16.3±1.0
传统入路组 63 517±11 630±15 420±11 269±9 18.2±2.3
t值 75 -6.097 -2.927 -8.928 -11.256 -32.767
P值 ? <0.05 <0.05 <0.05 >0.05 >0.05
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