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目的探讨原发性肝癌(HCC)手术切除的安全性、手术方式和相关技巧。方法回顾性分析近5年在我科施行手术治疗的原发性肝癌病例资料。结果有乙型肝炎病史31例,合并肝硬化41例。肝功能A级45例,B级23例,C级19例。施行左外叶切除19例,左半肝切除25例,右半肝切除17例,肝段切除26例。45例采用Pringle术,肝血流阻断时间为(15±5)min,最长25min;33例采用半肝血流阻断术,阻断时间为(25±8)min,最长47min;12例采用全肝血流阻断术,阻断时间为(12±4)min,最长者为17min。术中出血量为(1245±775)ml,输血量为(800±400)ml,手术时间为(215±85)min。术后并发症发生率为17%,严重并发症发生率为5%,死亡2例,住院时间为(20±8)d。术后1,3,5年存活率分别为73%,50%,37%。结论严格的术前评估、合理的手术方式和熟练的止血、切肝技术是确保手术安全、减少术后并发症、改善临床疗效的关键。
Objective To investigate the safety, surgical methods and related techniques of surgical resection of primary liver cancer (HCC). Methods Retrospective analysis of cases of primary liver cancer treated by surgery in our department in the past 5 years. The results of a history of hepatitis B in 31 cases, 41 cases of cirrhosis. Grade A liver function 45 cases, B grade 23 cases, C grade 19 cases. Nineteen patients underwent left lateral lobectomy, 25 underwent left hepatectomy, 17 underwent right hepatectomy, and 26 underwent hepatic segmentectomy. Among the 45 cases treated with Pringle, the blocking time of hepatic blood flow was (15 ± 5) min and the maximal time was 25 min. The occlusion time was (25 ± 8) min and the maximum was 47 min in 33 cases. Twelve patients underwent total hepatic vascular occlusion. The duration of interruption was (12 ± 4) min and the longest was 17 min. The blood loss was (1245 ± 775) ml and the volume of blood transfusion was (800 ± 400) ml. The operation time was (215 ± 85) min. The incidence of postoperative complications was 17%, the incidence of serious complications was 5%, 2 died and the length of stay was (20 ± 8) days. The survival rates at 1, 3 and 5 years after surgery were 73%, 50% and 37%, respectively. Conclusion Strict preoperative evaluation, rational operation and skilled hemostasis and hepatectomy are the keys to ensure the safety of operation, reduce postoperative complications and improve clinical efficacy.