摘要
目的探讨基层医院施行精准肝切除的可行性。方法回顾性分析临沧市人民医院2013年1月至2017年12月施行肝切除术的392例患者的临床资料,其中行精准肝切除术220例,非解剖性肝切除术172例,对2组患者的术前评估、手术规划、手术操作、术后管理及围手术期治疗、术中出血量、术后住院时间、肿瘤及结石复发率等进行总结分析。结果全组均完成手术,两组平均术中出血量、平均术后住院时间、胆汁漏发生率分别为,精准组(574.5±50.6) m L、(17.4±2.1) d、1.8%(4/220),非解剖组(894.6±55.7) m L、(25.2±3.6)d、 3.5%(6/172),2组比较有显著性差异(P<0.05),精准组优于非解剖组。手术时间、术后出血、多重耐药性感染率、肝周包裹性积液及术后肝衰竭发生率比较无显著性差异(P>0.05)。术后354例获随访(其中精准组201例,非解剖组153例),随访时间1个月至4 a,术后1 a、3 a无瘤生存率分别为,精准组79.6%(109/137)、50.4%(69/137),非解剖组56.8%(63/111)、37.8%(42/111),结石复发率分别为,精准组3.1%(2/64)、非解剖组19.0%(8/42),2组比较,差异有统计学意义(P<0.05),精准组优于非解剖组。结论精准肝切除具有术中出血少、术后住院时间缩短、患者术后无瘤生存率提高和结石复发率低的优势,在基层医院实施也能取得满意的效果。
Objective To explore the feasibility of precise hepatectomy in primary hospitals. Methods Theclinical data of 392 patients who underwent hepatectomy in Lincang People＇s Hospital from January 2013 toDecember 2017 were analyzed retrospectively. Of them,220 underwent precise hepatectomy,and 172 underwentnon anatomic hepatectomy. The preoperative evaluation, surgical planning, surgical operation, postoperativemanagement and perioperative treatment,intraoperative bleeding volume,postoperative hospital stay,tumor andstone recurrence rate were analyzed. Results The operation was completed in all groups,the average bleedingvolume,the average postoperative hospital stay and the incidence of bile leakage in the two groups were respectively.Accuracy group （574.5 ± 50.6 ）, （17.4 ± 2.1）, 1.8% （4/220）,Non anatomic group （894.6 ± 55.7）,（25.2 ± 3.6）,3.5% （6/172）,There was a significant difference between the two groups （ P〈0.05）,Theaccuracy group was better than the non anatomical group. There was no significant difference in operative time,postoperative hemorrhage,multidrug resistance infection rate,perihepatic Encapsulated Effusion and postoperativeliver failure rate （ P〉 0.05 ） . 354 cases were followed up （201 in precision group and 153 in non anatomicgroup ） . The follow-up period ranged from 1 months to 4a,The tumor free survival rates of 1a and 3a were respectively0,Accuracy group 79.6% （109/137）,50.4% （69/137）,non anatomical group 56.8% （63/111）,37.8% （ 42/111） . The recurrence rate of stones was respectively,The accuracy group was 3.1% （2/64）,and thenon anatomical group was 19% （8/42）,The difference between the two groups was statistically significant （ P〈0.05 ）,The accuracy group was better than the non anatomical group. Conclusion The precision hepatectomy hasthe advantages of less bleeding,shorter hospitalization time,higher postoperative survival rate and lower recurrencerate of calculi,and can also achieve satisfactory results in grass-roots hospitals.
作者
李留峥
王峻峰
罗明菊
张洪波
李波
保冰兵
李毅
徐雷升
LI Liu-zheng;WANG Jun-feng;LUO Ming-ju;ZHANG Hong-bo;LI Bo;BAO Bing-bing;LI Yi;XU Lei-sheng(Dept.of Hepatobiliary Surgery,Lincang People＇s Hospital,Lincang Yunnan 677000;Dept.ofHepatobiliary Surgery,First People＇s Hospital of Yunnan,Yunnan Kunming 650032,China)
出处
《昆明医科大学学报》
CAS
2018年第11期87-92,共6页
Journal of Kunming Medical University
基金
云南省科技惠民项目(2016RA011)
云南省卫生科技人才项目(D-201658)
关键词
基层医院
肝肿瘤
肝胆管结石
精准肝切除
Primary hospitals
Liver neoplasms
hepatolithiasis
Precise hepatectomy
