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目的评价精准肝切除术治疗肝脏肿瘤的近期疗效。方法将近2年内收治的143例肝脏肿瘤患者采用前瞻性、非随机对照临床试验的方法行精准肝切除84例(精准组)和行传统肝切除59例(对照组),比较两组手术后的近期效果。精准组采用肝段或肝叶切除方式,术中以半肝阻断或不阻断入肝血流为主。传统组采用肝门血流全阻断下大块钳夹缝扎法。结果精准组手术切除时间[(134±86)min]显著长于对照组[(71±52)min](P<0.01)。两组术中出血量分别为(274±186)mL和(340±220)mL,组间无统计学差异(P=0.055)。术后精准组当日引流量[(175±86)mL]显著少于对照组[(311±98)mL](P<0.01)。精准组术后3 d内血清ALT,AST,总胆红素,C反应蛋白峰值依次分别为(283.9±218.4)U/L,(215.5±171.3)U/L,(27.7±15.9)μmol/L,(35.4±17.3)mg/L,对照组分别为(754.5±273.0)U/L,(692.1±216.7)U/L,(46.3±20.1)μmol/L和(79.5±31.8)mg/L,两组间上述指标差异有统计学意义(均P<0.01)。精准组和对照组术后并发症发生率分别为10.7%和23.7%,差异有统计学意义(P=0.037),但均无围手术期死亡。结论精准肝切除以最小创伤和最大肝脏保护获得了较佳的康复效果,是一种安全、低创的肝切除方法。
Objective To evaluate the short-term curative effect of precision hepatectomy on liver tumors. Methods A total of 143 patients with liver cancer treated in recent 2 years underwent prospective, non-randomized controlled clinical trial of 84 cases (precision group) and 59 cases of conventional liver resection (control group) Recent effects. Precision group using liver segment or hepatectomy, intraoperative occlusion or not to block the hepatic blood flow-based. In the traditional group, hepatic portal blood flow was used to block the ligation of large jaws. Results The time of resection in the precision group was significantly longer than that in the control group [(134 ± 86) min [(71 ± 52) min] (P <0.01). The intraoperative blood loss was (274 ± 186) mL and (340 ± 220) mL, respectively, with no significant difference between the two groups (P = 0.055). The drainage volume of the postoperative precision group was significantly lower than that of the control group [(175 ± 86) mL] [(311 ± 98) mL] (P <0.01). The peak values of serum ALT, AST, total bilirubin and C-reactive protein in the precision group were (283.9 ± 218.4) U / L, (215.5 ± 171.3) U / L and (27.7 ± 15.9) μmol / L (35.4 ± 17.3) mg / L and (754.5 ± 273.0) U / L, (692.1 ± 216.7) U / L and (46.3 ± 20.1) μmol / L and The differences between the two groups were statistically significant (P <0.01). The incidences of postoperative complications in the precision group and the control group were 10.7% and 23.7%, respectively, with significant difference (P = 0.037), but no perioperative death was found. Conclusion Accurate hepatectomy with minimal trauma and maximum liver protection to obtain a better rehabilitation effect, is a safe, minimally invasive hepatectomy.