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目的探讨肝段染色指导下肝段切除术和术中灌注化疗栓塞治疗肝癌的临床效果。方法42例肝癌手术治疗者,其中20例肝癌患者术中应用B超引导肝段门静脉阻断灌注化疗栓塞并肝段染色后肝切除术(观察组),22例应用常规肝切除术(对照组)。两组均术后定期复查肝功能、AFP,CT及MRI的变化,并随访。结果观察组术中出血量为(295±105)mL,输血量(280±85)mL,术后1周肝功能指标超出正常范围者占15%(3/20),术后并发症发生率40.0%(8/20),术后3年生存率60.0%,术后3年局部复发率35.0%;对照组术中出血量(490±140)mL,输血量(370±105)mL,术后1周肝功能指标超出正常范围病例占40.9%(9/22),术后并发症发生率45.5%(10/22),术后3年生存率40.91%,术后3年局部复发率68.2%。观察组术中出血量、输血量、术后1周肝功能指标超出正常范围者比率、术后3年局部复发率均显著低于对照组(P<0.05),观察组术后3年生存率显著高于对照组(P<0.05),两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论肝段门静脉阻断灌注化疗栓塞并肝段染色后肝切除术可减少术后并发症,降低术后复发率,提高患者的生存率。
Objective To investigate the clinical effect of hepatic segmentectomy and intraoperative chemoembolization in the treatment of liver cancer. Methods Forty - two patients undergoing liver cancer surgery were treated with B - guided hepatic portal vein occlusion and hepatectomy (observation group). Twenty - two patients underwent hepatectomy (control group) ). The changes of liver function, AFP, CT and MRI in both groups were reviewed regularly and followed up. Results The intraoperative blood loss was (295 ± 105) mL and blood transfusion was (280 ± 85) mL in the observation group, and 15% (3/20) of patients whose liver function exceeded the normal range one week after operation. The incidence of postoperative complications 40.0% (8/20), the 3-year survival rate was 60.0% and the local recurrence rate was 35.0% at 3 years after operation. In the control group, the intraoperative blood loss (490 ± 140) mL and blood transfusion (370 ± 105) mL 40.9% (9/22) cases of liver function index exceeded the normal range after 1 week, the incidence of postoperative complications was 45.5% (10/22), the 3-year survival rate was 40.91% and the local recurrence rate was 68.2 %. The intraoperative blood loss, transfusion volume, the ratio of liver function index beyond the normal range in 1 week after operation and the local recurrence rate in 3 years after operation were significantly lower than those in control group (P <0.05). The 3-year survival rate (P <0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05). Conclusions Hepatic portal vein occlusion chemoembolization and segmental liver resection can reduce postoperative complications, reduce the recurrence rate and improve the survival rate of patients.