尾状叶与非尾状叶肝细胞癌患者手术切除疗效比较

摘要

目的：比较手术切除尾状叶与非尾状叶肝细胞癌患者的疗效。方法选取2008年1月至2012年1月在邢台市人民医院肝胆外科行尾状叶肝癌手术切除的患者37例作为观察组，另选同期行非尾状叶肝癌手术切除的37例作为对照组。比较两组患者的手术结果、并发症发生情况、病死率与复发率。结果观察组患者阻断血管时间、手术时间、住院时间显著长于对照组[（33±8） min比（22±5） min、（198±18） min比（124±16） min、（14.2±2.5） d比（10.0±2.1） d]，输血量、术中出血量显著高于对照组[（614±82） mL比（351±46） mL、（842±102） mL比（522±78） mL]，差异有统计学意义（ P＜0.05）。两组患者在肝衰竭、术后出血、胸腔积液、膈下积液发生率比较差异无统计学意义（P＞0.05）。观察组患者3年的病死率高于对照组[70.3％（26／37）比43.2％（16／37）]，3年的复发率也高于对照组[56.8％（21／37）比32.4％（12／37）]，差异有统计学意义（P ＜0.05）。结论尾状叶肝细胞癌患者行手术切除后的疗效相对差于非尾状叶肝细胞癌患者的疗效，可能与尾状叶肝癌患者的术中出血量较多、手术切缘不足等因素相关。%Objective To compare the surgical resection efficacy for caudate lobe and non-caudate lobe hepatocellular carcinoma patients.Methods Total of 37 liver cancer patients for caudate lobe resection in Department of Hepatobiliary Surgery of Xingtai City People′s Hospital from Jan.2008 to Jan.2012 were included in the study as the observation group,another 37 liver cancer patients for non-caudate lobe resection during the same period were included as the control group.The surgical outcomes,complications,mortality and recurrence rate of the two groups were compared.Results The block angiogenesis time,operation time, hospital stay of the observation group were longer than the control group[(33 ±8) min vs (22 ±5) min, (198 ±18) min vs (124 ±16) min,(14.2 ±2.5) d vs (10.0 ±2.1) d],the blood transfusion,intraopera-tive blood loss were higher than the control group[(614 ±82) mL vs (351 ±46) mL,(842 ±102) mL vs (522 ±78) mL],the differences were statistically significant(P<0.05).The liver failure,bleeding,pleural effusion,subphrenic complications of the two groups had no statistically significant differences(P>0.05).At 3 years after surgery,the mortality of the observation group was higher than the control group[70.3%(26/37) vs 43.2%(16/37)],the 3-year recurrence rate was higher than the control group[56.8%(21/37) vs 32.4%(12/37)],with the differences were statistically significant(P<0.05).Conclusion The effect of surgical resection of caudate lobe hepatocellular carcinoma is worse than the non-caudate lobe hepatocellular carcinoma,which might be related to more intraoperative blood loss,inadequate surgical margins and other factors.