肝癌解剖性与非解剖性切除对患者术后近期病死率的影响
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李敬东 E-mail:lijingdong358@126.com

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四川省教育厅科研项目(09ZA035)。


The impact of anatomic and non-anatomic liver resection on early mortality in patients with hepatocellular carcinoma: a prospective study
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    摘要:

    目的:探讨肝癌解剖性切除与非解剖性切除对患者术后近期病死率的影响,并分析肝癌切除术后与近期死亡相关的因素。
    方法:2006年8月—2009年1月,笔者行肝癌根治性切除52例,随机分为两组,甲组25例,采用解剖性肝癌切除术;乙组27例,采用非解剖性肝癌切除术。随访患者术后存活时间。
    结果:解剖性切除组1年病死率20.0%,非解剖性切除组1年病死率25.9%,两组间近期并发症发生人次及病死率无明显差异;但解剖性切除组术中出血量较非解剖性切除组少(P=0.006)。单因素分析和多因素分析提示,肝癌门静脉癌栓与近期病死率有关(P=0.019)。
    结论:肝癌解剖性切除与非解剖性切除对患者术后近期病死率无明显影响,肝癌门静脉癌栓可以成为预测术后早期死亡的主要因素。

    Abstract:

    Objective:To compare the impact of the type of resection (anatomic versus non-anatomic) on early mortality in patients with hepatocellular carcinoma (HCC) and to explore factors related to early mortality in patients after resection of hepatic tumor.
    Methods:Fifty-two patients with similar clinico-pathologic data were randomaly divided into 2 groups for curative liver resection for HCC, 25 patients underwent anatomic resection of at least one liver segment (group A) and 27 patients underwent non-anatomic resection (group B). We compared the age, gender, HbsAg, preoperative serum albumin, alpha-fetoprotein (AFP), postoperative pathologic diagnosis, TNM stage, tumor size, portal vein tumor thrombosis, duration of hospital stay and follow-up in the two groups.
    Results:The one year mortality was 20.0% in anatomic resection group and 25.9% in non-anatomic resection group. No significant difference was detected in early mortality and complications between the 2 groups. The blood loss during operation of anatomic resection group was less than that of non-anatomic resection group (P=0.006). Factor contributing to early mortality was presence of portal vein tumor thrombosis (P=0.019).
    Conclusions:There is no significant difference in early mortality between anatomic and non-anatomic liver resection. The presence of portal vein tumor thrombosis could be a major factor to predict early mortality.

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田云鸿|李敬东|李权林|李德新|李强.肝癌解剖性与非解剖性切除对患者术后近期病死率的影响[J].中国普通外科杂志,2011,20(1):23-26.
DOI:10.7659/j. issn.1005-6947.2011.01.006

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  • 收稿日期:2010-07-05
  • 最后修改日期:2010-11-23
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  • 在线发布日期: 2011-01-15