肝尾状叶肝细胞癌切除术式的选择：单独肝尾状叶切除还是联合肝叶切除？
Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe: isolated or combined lobectomy?
机构信息
Department of Hepatobiliary Surgery and Liver Transplantation Surgery, Navy General Hospital, Beijing, China.
出版信息
World J Gastroenterol. 2012 Aug 7;18(29):3904-9. doi: 10.3748/wjg.v18.i29.3904.
AIM
To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma (HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.
METHODS
Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010. In this series, left-sided, right-sided and bilateral approaches were used. The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared. The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.
RESULTS
Sixteen (44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20 (55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy. The median diameter of the tumor was 6.7 cm (range, 2.1-15.8 cm). Patients who underwent an isolated caudate lobectomy had significantly longer operative time (240 min vs 170 min), longer length of hospital stay (18 d vs 13 d) and more blood loss (780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy (P < 0.05). There were no perioperative deaths in both groups of patients. The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy (31.3% vs 10.0%, P < 0.05). The 1-, 3- and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%, 6.5% and 0% and 85.8%, 37.6% and 0%, respectively (P < 0.05). The corresponding overall survival rates were 73.8%, 18.5% and 0% and 93.1%, 43.6% and 6.7% (P < 0.05).
CONCLUSION
The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.
目的
使用 Cox 比例风险模型的多变量回归分析，探讨手术入路对尾状叶肝细胞癌（HCC）预后的意义。
方法
1995 年 1 月至 2010 年 6 月，在一家三级转诊中心，对 36 例 HCC 患者进行了尾状叶切除术。在本系列中，使用了左侧、右侧和双侧入路。比较了单独行尾状叶切除术和尾状叶切除术联合附加部分肝切除术的患者的结果。通过 Kaplan-Meier 法生成单独切除组和联合切除组的生存曲线，并通过对数秩检验进行比较。
结果
36 例患者中，16 例（44.4%）行单纯或部分尾状叶切除术，20 例（55.6%）行单纯或部分尾状叶切除术联合附加部分肝切除术。肿瘤的中位直径为 6.7cm（范围 2.1-15.8cm）。与行联合尾状叶切除术的患者相比，行单纯尾状叶切除术的患者手术时间明显延长（240min 比 170min），住院时间延长（18d 比 13d），出血量增加（780mL 比 270mL）（P<0.05）。两组患者均无围手术期死亡。单纯行尾状叶切除术的患者并发症发生率高于联合行尾状叶切除术的患者（31.3%比 10.0%，P<0.05）。单纯行尾状叶切除术和联合行尾状叶切除术组的 1、3、5 年无病生存率分别为 54.5%、6.5%和 0%和 85.8%、37.6%和 0%（P<0.05）。相应的总生存率分别为 73.8%、18.5%和 0%和 93.1%、43.6%和 6.7%（P<0.05）。
结论
尾状叶切除术联合附加部分肝切除术是首选方法，因为该方法技术要求较低，可提供足够的手术切缘。
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