规则性肝切除与非规则性肝切除术后肝癌肝内复发情况比较

摘要

Objective To compare the intrahepatic recurrence of hepatocellular carcinoma after regular hepa-tectomy and irregular hepatectomy. Methods One hundred and twenty patients with primary liver cancer undergoing hepatectomy in our department from 2007 to 2012 were selected, which were divided into regular hepatectomy group and irregular hepatectomy group, with 60 patients in each group. General surgery condition, the liver function after six months, the recurrence rate after one year and the survival rate were compared between the two groups. Results The diameter of tumor removed, volume of liver removed, blood loss, blood transfusion, the number of hepatic resection in regular hepatectomy group were significantly higher than those in irregular hepatectomy group, P<0.01. Six months af-ter surgery, serum albumin (ALB) was significantly higher in regular hepatectomy group than irregular hepatectomy group, while TBIL, glutamic-pyruvic transaminase (ALT) and total bilirubin (DBIL) were significantly lower (P<0.01). The 1-year recurrence rate in regular hepatectomy group was significantly lower than that in irregular hepatecto-my group, while 1-year disease-free survival rate and 1-year overall survival rate in regular hepatectomy group were significantly higher (P<0.05). Conclusion Although regular hepatectomy results in larger surgical injury, it has the advantages of larger range of resection, better postoperative recovery and lower recurrence rate, which is suitable for clinical applications.%目的：对比规则性肝切除与非规则性肝切除术后肝癌肝内复发情况。方法选取我科2007-2012年行肝切除术治疗原发性肝癌的患者共120例，按照术式分为规则性肝切除组和非规则性肝切除组各60例。比较两组患者的一般手术情况、术后6个月肝功能和术后1年复发率、生存率。结果规则肝切除组的切除肿瘤直径、切除肝脏体积、术中出血量、输血量、切除肝段数目显著高于非规则肝切除组(P<0.01)。规则肝切除组术后6个月的血清白蛋白(ALB)显著高于非规则肝切除组，总胆红素(TBIL)、谷丙转氨酶(ALT)和直接胆红素(DBIL)显著低于非规则肝切除组(P<0.01)。规则肝切除组术后1年复发率显著低于非规则肝切除组，术后1年无瘤生存率和总生存率显著高于非规则肝切除组(P<0.05)。结论规则性肝切除虽然手术损伤较大，但切除肿瘤范围大，术后肝功能恢复好，复发率低，适合临床应用。