Application value of precision hepatectomy in hepatocellular carcinoma with liver cirrhosis / 国际外科学杂志

ABSTRACT

Objective To explore the clinical value of precision hepatectomy in primary hepatocellular carcinoma (HCC) with liver cirrhosis.Methods The clinical data of 115 cases of HCC with liver cirrhosis treated in the Second Affiliated Hospital of Chongqing Medical University from January 2015 to October 2017 were retrospectively analyzed,including 94 males and 21 females with an average age of 52.6 years.Based on whether the operation was performed according to the concept of precision hepatectomy,the patients were divided into two groupsthe traditional group (49 cases with liver resection in accordance with traditional surgical procedures) and the precision group(66 cases with liver resection in accordance with precise surgical procedures).The follow-up observation by telephone lasted one year after surgery,focusing on postoperative tumor recurrence and survival of the patients.Comparison of operation time,intraoperative blood loss,perioperative blood transfusion rate,total hepatic blood flow block rate,postoperative complication rate,postoperative hospital stay,postoperative pathology and follow-up results were made.Measurement data with normal distribution were expressed as mean ±standard deviation (Mean±SD),and the comparative analysis between the groups was performed by t test;Measurement data with skewed distribution were expressed as M(P25,P75),and comparison between groups was analyzed using Wilcoxon rank sum test.Count data and grade data were analyzed by chi-square test or Fisher exact test.Results In terms of some parameters of the traditional group in the perioperative period,the operation time,intraoperative blood loss,perioperative blood transfusion rate,total hepatic blood flow block rate,postoperative complication rate,postoperative hospital stay were respectively (201.4 ±79.1) min,250(80,500) ml,57.1％ (28/49),71.4％ (35/49),57.1％ (28/49) and (14.3 ± 3.7) d;and those of the precision group were respectively (188.3 ± 59.3) min,200 (50,350) ml,15.2％ (10/66),47.0％ (31/66),27.3％ (18/66) and (8.2 ± 4.4) d,the results in precision group were all significantly better than those in the traditional group.The difference between the two groups was statistically significant (P ＜0.05).In postoperative pathological examination and follow-up observation,results show thatthe residual cancer rate of the precision group [1.5％ (1/66)] was significantly lower than that of the traditional group [12.2％ (6/49)] (P ＜ 0.05).As to the cumulative survival rate after surgery,the traditional group was 67.3％ (33/49) and the precision group was 77.3％ (51/66),with the precision group a little higher.But the difference was not statistically significant (P ＞ 0.05).As to the tumor recurrence rate,the traditional group was 63.3％ (31/49) and 28.8％ (19/66) in the precision group.The difference was statistically significant(P ＜ 0.05).Conclusion Precise hepatectomy can effectively reduce the surgical risk of HCC and improve the prognosis of patients with liver cancer,and has good clinical application value.