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目的:探讨微波固化在肝硬化肝癌不规则性肝切除术中的应用价值。方法:回顾性分析第四军医大学唐都医院普外科2011年1月-2013年4月行不规则性肝切除肝硬化肝癌患者158例的临床资料,其中男性96例,女性62例,年龄32-65岁(47.7±9.4)。乙型肝炎后肝硬化58例,酒精性肝硬化21例。肝功能分级:Child-Pugh A级116例,B级42例。不规则性肝切除组(Ⅰ组)77例,微波固化+不规则性肝切除组(Ⅱ组)81例,两组在性别构成、年龄、肝炎病史、肝癌病史、门静脉高压症、AFP、PLT、Child-Pugh评分、肝功能(白蛋白、谷丙转氨酶、总胆红素、凝血酶原时间)等无显著差异(P>0.05)。比较分析两组术中肝门阻断、出血量、输血量、手术时间、术后肝功能恢复及术后并发症的发生率情况。结果:微波固化+不规则性肝切除术组无肝门阻断,且在手术时间、出血量、补血量、补液量、住院时间、术后住院时间明显少于不规则性肝切除术组(P<0.05)。而在淋巴结清扫数目、围手术期死亡率无显著差异(P>0.05)。在术后1天、3天和7天时,两组在白蛋白、总胆红素、凝血时间无显著差异(P>0.05),术后1天、3天谷丙转氨酶无显著差异(P>0.05),术后7天时Ⅱ组较Ⅰ组恢复快(P<0.05)。Ⅱ组术后并发症发生率明显少于Ⅰ组。结论:微波固化在不规则性肝切除术中无需行肝门阻断,具有出血少、输血少、手术时间短、术后住院时间短等优点。微波固化联合不规则性肝切除术在肝硬化肝癌中具有良好效果。
Objective: To investigate the value of microwave curing in hepatectomy of liver cirrhosis. Methods: The clinical data of 158 patients with hepatic cirrhosis with hepatic cirrhosis from January 2011 to April 2013 were retrospectively analyzed. Among them, 96 males, 62 females and 32 males -65 years old (47.7 ± 9.4). Post-hepatitis B cirrhosis in 58 cases, alcoholic cirrhosis in 21 cases. Liver function grading: Child-Pugh A-class 116 cases, B-class 42 cases. There were 77 cases of irregular hepatectomy group (Ⅰ group) and 81 cases of microwave solidification + irregular hepatectomy group (Ⅱ group). There were no significant differences in gender, age, history of hepatitis, history of hepatocellular carcinoma, portal hypertension, AFP, PLT , Child-Pugh score, liver function (albumin, alanine aminotransferase, total bilirubin, prothrombin time) were not significantly different (P> 0.05). The incidence of hepatic portal occlusion, blood loss, blood transfusion, operation time, postoperative liver function recovery and postoperative complications were compared between the two groups. Results: There was no hepatic portal vein occlusion in the group of microwave-cured and irregular hepatectomy, and the operation time, blood loss, blood volume, fluid volume, length of hospital stay and postoperative hospital stay were significantly less than those in the group of irregular hepatectomy P <0.05). In the number of lymph node dissection, there was no significant difference in perioperative mortality (P> 0.05). There were no significant differences in albumin, total bilirubin and clotting time between the two groups at 1 day, 3 days and 7 days after operation (P> 0.05). There was no significant difference in ALT between 1 and 3 days after operation (P> 0.05 ), And the recovery of group Ⅱ was faster than that of group Ⅰ at 7 days after operation (P <0.05). The incidence of postoperative complications in group Ⅱ was significantly less than that in group Ⅰ. Conclusion: Microwave-assisted hepatectomy without irregular hepatectomy has the advantages of less bleeding, less blood transfusion, shorter operative time and shorter postoperative hospital stay. Microwave curing combined with irregular hepatectomy has a good effect in liver cirrhosis.