Application value of subsegmentectomy in radical resection of hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2021.03.012

Abstract

Abstract:

Objective

To evaluate the application of subsegmentectomy in the radical resection of hepatocellular carcinoma (HCC).

Methods

Clinical data of 158 patients with HCC who underwent anatomical hepatectomy in Chenzhou First People's Hospital from October 2017 to October 2019 were retrospectively analyzed. Among them, 100 patients were male and 58 female, aged (44±10) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 73 patients underwent anatomical resection of liver subsegment (subsegment group) and 85 cases received irregular hepatectomy (control group). Intraoperative condition, postoperative liver function and the incidence of complications were statistically compared between two groups. The ALT level was compared between two groups by t test. The incidence of postoperative complications was compared by Chi-square test or Fisher's exact probability test.

Results

In subsegment group, the ALT levels at postoperative 5, 9 and 14 d were (147.0±8.8), (52.0±2.1) and (30.0±1.4) U/L, significantly lower than (371.0±19.3), (126.0±9.2) and (50.0±2.4) U/L in control group (t=-3.10, -3.03, -2.77; P<0.05), respectively. In subsegment group, no bile leakage occurred and 1 case of perihepatic encapsulated effusion was reported, and accordingly 4, 6 cases in control group, and significant differences were obeserved between two groups (χ²=-, 4.58; P<0.05). In subsegment group, the length of postoperative hospital stay was (10.3±2.3) d, significantly shorter than (14.5±3.4) d in control group (t=-2.87, P<0.05). No perioperative death occurred in two groups.

Conclusions

Subsegmentectomy can preserve the effective liver tissues to a large extent, which has the advantages of rapid recovery and safety.

Key words: Carcinoma, hepatocellular, Hepatectomy, Perioperative care

Aowen Xie, Yi Yu, Xinran Peng, Pan Wang, Huijun Liao. Application value of subsegmentectomy in radical resection of hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(03): 290-295.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2021.03.012

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2021/V10/I03/290

Figures/Tables 4

References 22

[1]	李相成，江王杰. 解剖性肝切除的沿革[J]. 外科理论与实践, 2020, 25(1):20-24.
[2]	竜崇正，赵明浩. 肝脏局部解剖——以门静脉分段为基础的思路[M]. 王继春, 马笑雪, 译. 沈阳: 辽宁科学技术出版社, 2016:21-42.
[3]	张克明，赵新，洪智贤, 等. 术中超声在亚肝段为主的肝切除治疗肝癌合并门静脉高压症中的应用价值[J]. 临床外科杂志, 2017, 25(3):198-200.
[4]	Takasaki K. Glisson蒂横断式肝切除术[M]. 吕毅, 李宗芳, 译. 北京: 人民卫生出版社, 2008:23-76.
[5]	王峰杰，甑作均，陈焕伟. Glisson蒂横断式肝中叶切除治疗合并肝硬化的肝细胞癌安全性及疗效[J/CD]. 中华肝脏外科手术学杂志, 2018, 7(6):465-468.
[6]	Hidaka M, Eguchi S, Okuda K, et al. Impact of anatomical resection for hepatocellular carcinoma with microportal invasion (vp1): a multi-institutional study by the Kyushu study group of liver surgery[J]. Ann Surg, 2020, 271(2):339-346.
[7]	Feng X, Su Y, Zheng S, et al. A double blinded prospective randomized trial comparing the effect of anatomic versus non-anatomic resection on hepatocellular carcinoma recurrence[J]. HPB, 2017, 19(8):667-674.
[8]	方驰华，胡浩宇，刘允怡, 等. 数字智能化诊疗技术在解剖性肝切除中应用价值[J]. 中国实用外科杂志, 2019, 39(6):545-551.
[9]	姚舜禹，荚卫东，葛勇胜, 等. 吲哚氰绿荧光示踪技术在肝癌解剖性肝切除中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(3):221-225.
[10]	尹新民，朱斯维. 腹腔镜肝切除术的进展[J]. 中国普外基础与临床杂志, 2019, 26(2):129-132.
[11]	黄志勇，陈孝平. 肝硬化与肝癌肝切除的科学决策[J]. 临床外科杂志, 2019, 27(8):631-633.
[12]	韦萍，樊云清，陈闯, 等. 术中超声在肝肿瘤切除术中的应用价值[J]. 中国现代普通外科进展, 2019, 22(8):639-641.
[13]	李留峥，王峻峰，罗明菊, 等. 精准肝切除术临床应用[J/CD].中华肝脏外科手术学电子杂志, 2019, 8(2):113-117.
[14]	Cai SW, Yang SZ, Lv WP, et al. Sustained methylene blue staining to guide anatomic hepatectomy for hepatocellular carcinoma: initial experience and technical details[J]. Surgery, 2015, 158(1):121-127.
[15]	沈锋. 腹腔镜肝叶切除的纷争[J/CD]. 中华普外科手术学杂志（电子版）, 2018, 12(5):368-371.
[16]	赵鹏翔，杨雨菲，张东杰, 等. 三维重建技术在肝癌治疗中的应用研究进展[J]. 中国现代普通外科进展, 2018, 21(9):706-710, 728.
[17]	李博，林杰. 肝脏三维重建技术较传统CT成像技术对肿瘤体积可提供更准确的术前评估[J]. 中国组织工程研究, 2020, 24(11): 1726-1732.
[18]	李锟，张中林，刘权焰, 等. 三维可视化技术联合术中ICG荧光显像在腹腔镜肝癌肝切除术中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(3):226-229.
[19]	郑树国. 循肝静脉路径肝切除解剖学基础和临床价值[J]. 中国实用外科杂志, 2018, 38(4):360-362.
[20]	杨禄坤，范东毅，孔凡根, 等. 低中心静脉压技术在肝硬化患者腹腔镜肝切除术中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(2):139-142.
[21]	王新青，卜阳，于松宁, 等. 精准肝切除治疗原发性肝癌近期疗效的Meta分析[J]. 中国普通外科杂志, 2016, 25(1):57-67.
[22]	沈伟峰，蔡文昌，耿利, 等. 肝Ⅷ段大肝癌手术切除安全性及疗效分析[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(2):122-126.

组别	例数	年龄（岁，±s）	性别（例）		HBsAg （例）		Child-Pugh分级
组别	例数	年龄（岁，±s）	男	女	+	-	A	B
亚段组	73	42±11	46	27	35	38	73	0
对照组	85	45±12	54	31	43	42	85	0
统计值		t=-1.63	χ²=2.22		χ²=1.94		-
P值		>0.05	>0.05		>0.05		-

组别	例数	年龄（岁，±s）	性别（例）		HBsAg （例）		Child-Pugh分级
组别	例数	年龄（岁，±s）	男	女	+	-	A	B
亚段组	73	42±11	46	27	35	38	73	0
对照组	85	45±12	54	31	43	42	85	0
统计值		t=-1.63	χ²=2.22		χ²=1.94		-
P值		>0.05	>0.05		>0.05		-

组别	例数	手术时间（min，±s）	术中出血量（ml，±s）	术后出血（例）	胆漏（例）	术后肝衰竭（例）	胸腔积液（例）	肝周包裹性积液（例）	多重耐药菌感染（例）	术后住院时间（d，±s）
亚段组	73	305±36	517±56	1	0	0	2	1	1	10.3±2.3
对照组	85	252±50	528±65	1	4	0	6	6	2	14.5±3.4
统计值		t=2.87	t=-1.12	-	-	-	χ²=2.86	χ²=4.58	χ²=0.59	t=-2.87
P值		<0.05	>0.05	>0.05	<0.05	>0.05	>0.05	<0.05	>0.05	<0.05

组别	例数	手术时间（min，±s）	术中出血量（ml，±s）	术后出血（例）	胆漏（例）	术后肝衰竭（例）	胸腔积液（例）	肝周包裹性积液（例）	多重耐药菌感染（例）	术后住院时间（d，±s）
亚段组	73	305±36	517±56	1	0	0	2	1	1	10.3±2.3
对照组	85	252±50	528±65	1	4	0	6	6	2	14.5±3.4
统计值		t=2.87	t=-1.12	-	-	-	χ²=2.86	χ²=4.58	χ²=0.59	t=-2.87
P值		<0.05	>0.05	>0.05	<0.05	>0.05	>0.05	<0.05	>0.05	<0.05

Please choose a citation manager

Content to export