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不规则肝中叶切除术联合交替区域性血流阻断在中央型肝肿瘤中的应用

Application of irregular mesohepatectomy with alternating regional blood occlusion for central liver tumors.

作者信息

Wen Yu, Xiong Li, Hu Jixiong, Dai Wei Dong, Liu Wei, Miao Xiongying

机构信息

Division of Hepatobiliary Disease, Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.

出版信息

Hepatogastroenterology. 2011 Mar-Apr;58(106):318-23.

Abstract

BACKGROUND/AIMS: Mesohepatectomy is rarely used to treat central liver tumors because of its technical complexity. This retrospective study aimed to evaluate the application of irregular mesohepatectomy with alternating regional blood occlusion for central liver tumors.

METHODOLOGY

From 2003 to 2008, 128 patients with central liver tumors were treated by irregular mesohepatectomy (Group I, n=85) and anatomic mesohepatectomy (Group II, n=43) respectively. The clinical profiles and follow-up data, including the operation time, bleeding volume, blood transfusion volume, postoperative recovery of liver function and postoperative complications, were compared among the two groups. Kaplan-Meier analysis was made for survival rates comparison.

RESULTS

The average operative durations were 195.1 +/- 52.4 min and 264.3 +/- 57.3 min in Group I and Group II, respectively. There was significant difference between the two groups in incidence of postoperative biliary fistula (18.8% vs 9.3%, p<0.05), but not in bleeding volume, blood transfusion volume, post-operative LFT changes and 1, 3 and 5-year survival rates. Kaplan-Meier survival analysis showed no significant difference between the two groups on survival rate.

CONCLUSION

Irregular mesohepatectomy with alternating regional blood occlusion can achieve an efficacy comparable to anatomic mesohepatectomy.

摘要

背景/目的:由于技术复杂性,肝中叶切除术很少用于治疗肝中央区肿瘤。本回顾性研究旨在评估不规则肝中叶切除术联合交替区域血流阻断术在肝中央区肿瘤治疗中的应用。

方法

2003年至2008年,128例肝中央区肿瘤患者分别接受不规则肝中叶切除术(I组,n = 85)和解剖性肝中叶切除术(II组,n = 43)。比较两组患者的临床资料和随访数据,包括手术时间、出血量、输血量、术后肝功能恢复情况及术后并发症。采用Kaplan-Meier分析比较生存率。

结果

I组和II组的平均手术时间分别为195.1±52.4分钟和264.3±57.3分钟。两组术后胆瘘发生率有显著差异(18.8%对9.3%,p<0.05),但在出血量、输血量、术后肝功能变化及1、3和5年生存率方面无显著差异。Kaplan-Meier生存分析显示两组生存率无显著差异。

结论

不规则肝中叶切除术联合交替区域血流阻断术可取得与解剖性肝中叶切除术相当的疗效。

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