不同技术在精准肝切除术中应用价值比较

摘要

Objective To investigate the application value of different techniques in precise hepatectomy.Methods From March 2011 to October 2015,80 patients who underwent hepatectomy in the department of hepatobiliary surgery in our hospital were enrolled in the study and were randomly divided into the experimental group and the control group with 40 cases in each group.Both groups were treated by precise hepatectomy.The control group underwent two-dimensional CT examination while the experimental group underwent three-dimensional reconstruction examination.The operation related indexes (duration of operation,intraoperative bleeding volume,postoperative length of hospital stay),lesion evaluation indexes (lesion volume,predicted removed liver volume,residual liver volume),liver function indexes [alanine aminotransferase (ALT),total bilirubin (TBiL),aspartate aminotransferase (AST)] and the incidence of postoperative complications were observed.Results The average duration of operation,postoperative length of hospital stay,intraoperative blood loss,lesion volume,predicted removed liver volume,residual liver volume and preoperative liver function indexes showed no significant differences (P ＞ 0.05).Only in the experimental group,the predicted removed liver volume and postoperative actually removed liver volume were correlated (r =0.225,P ＜ 0.05);after operation,liver function indexes in the experimental group were significantly lower than that those before operation and those in the control group after operation (P ＜ 0.05);The incidence of postoperative complications in the experimental group (5.00％) was significantly lower than that in the control group (22.50％) (x2 =5.165,P ＜ 0.05).Conclusion Three-dimensional reconstruction is of high application value in precise hepatectomy,and it is of important significance in development of treatment plan and improving prognosis.%目的 探讨不同技术在精准肝切除术中应用价值比较.方法 收集2011年3月～2015年10月我院肝胆外科收治的80例行肝癌切除术患者为研究对象,随机数字表法均分为实验组及对照组各40例,2组患者均行精准肝切除术,对照组术前行二维CT检查,实验组另行三维重建技术检查,观察2组手术相关指标[手术时间、术中出血量、术后住院天数]、病灶评估指标[病灶体积、预切除肝脏体积、剩余肝脏体积]、肝功能指标[谷丙转氨酶(ALT)、总胆红素(TBiL)、谷草转氨酶(AST)]及术后并发症发生率.结果 2组平均手术时间、术后住院天数、术中出血量、病灶体积、预切除肝脏体积、剩余肝脏体积、术前肝功能指标相较无明显差异(P＞0.05),仅实验组测算的预切除肝脏体积与术后实际切除肝脏质量具有相关性(r=0.225,P＜0.05);术后仅实验组肝功能指标较术前明显降低,且术后实验组肝功能指标较对照组明显低,有统计学意义(P＜0.05);实验组术后并发症总发生率5.00％较对照组22.50％明显低(x2 =5.165,P＜0.05).结论 三维重建技术在精准化肝切除术中有较高应用价值,在指导手术方案制定及预后效果方面有重要临床意义.