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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 200 -203. doi: 10.3877/cma.j.issn.1674-3946.2022.02.022

论著

解剖性与非解剖性肝切除术治疗肝胆管结石合并肝内胆管癌的临床研究
陈祥1,(), 吉韬1, 董仁华1   
  1. 1. 620010 四川眉山,四川大学华西医院眉山医院肝胆胰外科
  • 收稿日期:2021-02-20 出版日期:2022-04-26
  • 通信作者: 陈祥

Clinical study of anatomical and non-anatomical hepatectomy for hepatolithiasis-associated intrahepatic cholangiocarcinoma

Xiang Chen1,(), Tao Ji1, Renhua Dong1   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, Meishan Hospital, West China Hospital, Sichuan University, Meishan Sichuan Province 620010, China
  • Received:2021-02-20 Published:2022-04-26
  • Corresponding author: Xiang Chen
  • Supported by:
    Sichuan Medical(Youth Innovation)Research Project Subject(Q19062); Sichuan Health Research Institute Subject(20PJ272)
引用本文:

陈祥, 吉韬, 董仁华. 解剖性与非解剖性肝切除术治疗肝胆管结石合并肝内胆管癌的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(02): 200-203.

Xiang Chen, Tao Ji, Renhua Dong. Clinical study of anatomical and non-anatomical hepatectomy for hepatolithiasis-associated intrahepatic cholangiocarcinoma[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 200-203.

目的

探讨解剖性与非解剖性肝切除术治疗肝胆管结石合并肝内胆管癌(HICC)的临床疗效。

方法

前瞻性纳入2017年1月至2020年6月64例HICC患者的临床资料,随机分为非解剖组和解剖组各32例。非解剖组行非解剖性肝切除术,解剖组行解剖性肝切除术。采用软件SPSS 22.0处理数据,围术期指标、肝功能指标等计量资料以(

xˉ
±s)表示,行独立样本t检验;术后并发症等计数资料以n(%)表示,行χ2检验;生存分析采用Kaplan-Meier法并行Log-rank检验。P<0.05表示差异有统计学意义。

结果

解剖组手术时间长于非解剖组(P<0.05),解剖组术中出血量、术中输血量、手术切缘均明显优于非解剖组(P<0.05);解剖组患者术后第1 d、3 d、7 d总胆红素(TBil)、谷草转氨酶(AST)、谷丙转氨酶(ALT)水平均显著低于非解剖组(P<0.05),血清白蛋白(ALB)水平显著高于非解剖组(P<0.05);解剖组患者术后总并发症发生率较非解剖组显著降低(9.4% vs. 31.3%,P<0.05);术后随访7~48个月,中位随访28个月,解剖组与非解剖组两组患者的累积总生存率(53.1% vs. 56.3%)及无病生存率(37.5% vs. 46.9%)比较,差异均无统计学意义(Log Rank χ2=0.084、0.547,P=0.772、0.460)。

结论

解剖性肝切除术虽然操作复杂,延长了手术时间,但更加精细化,不仅提高了手术的安全性,而且也有利于患者术后肝功能恢复、减少术后并发症。

Objective

To investigate the clinical efficacy of anatomic and non-anatomic hepatectomy for hepatolithiasis-associated intrahepatic cholangiocarcinoma(HICC).

Methods

Clinical data of 64 patients with HICC from January 2017 to June 2020 were prospectively included. They were randomly divided into non-anatomical group and anatomical group,each of 32 cases. The non-anatomical group underwent non-anatomical hepatectomy,while the anatomical group underwent anatomical hepatectomy. SPSS 22.0 software was used for data processing. Perioperative indexes,liver function indexes and other measurement data were expressed as(

xˉ
±s),and independent t test was performed. Postoperative complications was expressed as n(%)and χ2 test was performed;Kaplan Meier method and log-rank test were used for survival analysis. P<0.05 indicated statistically significant difference.

Results

The operative time of the anatomical group was longer than that of the non-anatomical group,and the intraoperative blood loss,intraoperative blood transfusion and surgical margin of the anatomic group were significantly better than those of the non-anatomic group(P<0.05),while there was no statistical difference in the postoperative hospital stay between the two groups(P>0.05).The levels of TBil,AST and ALT in anatomical group on day 1,3 and 7 after surgery were significantly lower than those in non-anatomical group(P<0.05),and the level of ALB in anatomical group was significantly higher than that in non-anatomical group(P<0.05). The incidence of postoperative complications in the anatomical group was significantly lower than that in the non-anatomical group(9.4% vs. 31.3%,P<0.05). The follow-up was 7~48 months,and the median was followed up for 28 months,there was no significant difference in the cumulative overall survival rate(53.1% vs. 56.3%)and disease-free survival rate(37.5%vs.46.9%)between the two groups(log-rank χ2=0.084,0.547,P=0.772,0.460).

Conclusion

Although the operation of anatomical hepatectomy is complex and prolongs the operation time,it is more refined,which not only improve the safety of operation,but also benefit the recovery of postoperative liver function and reduce postoperative complications.

表1 64例HICC患者不同肝切除术式两组患者一般资料[(
xˉ
±s),例]
表2 64例HICC患者不同肝切除术式两组患者围术期指标(
xˉ
±s
表3 64例HICC患者不同肝切除术式两组患者肝功能指标(
xˉ
±s
表4 64例HICC患者不同肝切除术式两组患者术后并发症情况[例(%)]
图1 64例HICC患者不同肝切除术式两组患者累积总生存和无病生存曲线
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