摘要
目的探讨间歇性肝门阻断对原发性肝癌术后肝内转移的影响。方法回顾性分析335例原发性肝癌患者临床资料。所有患者均行肝叶切除术，以阻断入肝血流的方法分为两组：（1）间歇性肝门阻断组：97例，Pringle方法间歇性阻断肝门，每个循环阻断15min，开放5min。可重复2～3个循环。（2）其他阻断方法（对照）组：238例，包括预处理阻断法、单纯Pringle法、选择性入肝血流阻断法等。术后每4周，定期复查肝脏功能各项指标及甲胎蛋白，肝脏彩色多普勒超声和（或）CT、MRI，平均随访26．5个月。结果围手术期死亡6例（1．8％）。间歇性肝门阻断组1、2年复发率分别为31．6％（30／95）和48．4％（46／95），明显高于对照组的21．4％（50／234）和38．0％（89／234）（P〈O．05）。间歇性肝门阻断组1、2年的生存率分别为70．5％（67／95）和53．7％（51／95），与对照组的68．8oA（161／234）和55．6％（130／234）比较，无统计学差异（P〉0．05）。为排除其他肝内复发相关因素的影响，我们调整了观察病例标准：肿瘤≥5cm；术后4周AFP降至正常；术中B超阴性。间歇性肝门阻断组与对照组纳入病例分别为79例和155例。结果两组1、2年复发率分别为29．1％比18．7％和46．8％比35．5％，间歇性肝门阻断组仍明显高于对照组（P〈0．05），但1、2年生存率无明显差别。结论间歇性肝门阻断是导致原发性肝癌术后早期肝内复发的一项危险因素，临床应慎用。
Objective To investigate the impact of intermittent porta hepatis occlusion on post- operative intra hepatic recurrence of hepatocellular carcinoma. Methods We retrospectively reviewed the records of 335 patients who underwent partial hepatectomy. The patients were classified into 2 groups： （1） the study group （n=97） ： porta hepatis was occluded with intermittent Pringle maneu- ver with 2-3 cycles of clamp/unclamp time of 15 min/5 min, repeated 2-3cycles; （2） the control group （n=238）： including using Pringle maneuver, preconditioning occlusion of porta hepatis and selective occlusion of portal blood inflow. Patients were followed-up in the Outpatient Department once every 2-3 weeks in the 1st year, and once every 3-6 weeks in the 2nd year with US/CT/MRI and serum AFPtest. The mean duration of follow up was 26.5 months. Results The perioperative mortality was 1.8G （6/335）. Turnout recurrence in the study group was 31.6% and 48.4% in the 1st and 2nd year, respectively. The recurrence rates were significantly higher than the 21.4% and 38.0% in the control group （P〈0.05）. To exclude the miscellaneous factors which were involved in intra-hepatic recurrence of HCC, we set up 3 criteria to include patients for subgroup analysis： tumor ≥5 cm; ser- um AFP decreased to normal level within 4 weeks;negative intra operative US scan. The number of patients included were 79 and 155 in the study and the control groups, respectively. There were signif- icant differences in recurrence rate between the study and the control groups in the 1st and 2nd year （29.1% vs 18.7% ,46.8% vs 35.5%, P〈0.05）. There were no significant differences in overall sur- vival rate between the two groups. Conclusions Intermittent porta hepatis occlusion is a risk factor of postoperative intra-hepatic recurrence of hepatoeellular carcinoma.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2013年第5期321-324,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
间歇性肝门阻断
原发性肝癌
肝内复发
Intermittent porta hepatis occlusion
Hepatocellular carcinoma
Intra-hepatic recurrence
