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目的 :对超声肝切除技术 (USD)在肝门部肿瘤切除中的应用进行临床研究和探讨。方法 :自 1991年 4月～ 1999年 3月 ,行超声肝切除术的肝门部原发肝癌患者 75例 (T组 ) ,同期 81例肝门部肝癌患者行常规肝切除手术 (C组 )。两组患者的年龄、性别分布及肝功能状况等主要临床资料无显著差异。对两组手术切除率、平均手术时间、住院死亡率、平均出血量和输血量、平均留院时间、并发症发生情况以及 1,3年生存率进行比较 ,评估手术技术的影响。结果 :两组患者均未出现手术死亡或术后住院死亡。T组手术切除率较C组有显著提高。T组的平均手术时间 (15 0± 10 .5min)明显少于C组 (2 36± 17.8min ,P <0 .0 1) ;T组的平均出血量(4 2 1± 13.1ml)和输血量 (36 4± 15 .9ml)与C组 (分别为 70 6± 2 3.0ml,5 48± 19.3ml)相比较有显著差异 (P <0 .0 1) ;平均留院时间T组 (8.2± 0 .47d)较C组 (14.1± 0 .6 0d)明显缩短 (P <0 .0 1) ,T组总并发症发生也较C组显著减少。统计显示 ,T组患者 1,3年生存率较C组显著提高 (P <0 .0 1)。结论 :超声肝切除技术由于可以选择性地暴露肝内管道组织 ,为肝门部肿瘤、大肝癌 ,尤其是侵犯大血管或胆道的肿瘤切除提供了一项新的途径。
Objective: To investigate the clinical application of ultrasonic liver resection (USD) in the resection of hilar tumors. Methods: From April 1991 to March 1999, 75 patients with primary hepatocellular carcinoma (T group) underwent hepatectomy undergoing hepatic echocardiography and 81 patients with hepatic hilar hepatocellular carcinoma underwent hepatectomy (Group C) . The two groups of patients age, gender distribution and liver function status and other major clinical data no significant difference. Surgical resection rate, average operation time, hospital mortality, average blood loss and blood transfusion, average stay in hospital, complication and 1, 3 year survival rate were compared to evaluate the impact of surgical technique. Results: No operative death or postoperative hospitalization occurred in either group. The resection rate of T group was significantly higher than that of C group. The average operative time in T group was significantly lower than that in C group (15 ± 10, 5 min, 2 36 ± 17.8 min, P <0.01). The mean amount of bleeding in group T (42 ± 13.1 mL) and transfusion (36 4 ± 15 .9 ml) were significantly different from those in group C (70 6 ± 2 3.0 ml and 5 48 ± 19.3 ml respectively) (P 0. 01) ± 0.47d) were significantly shorter than those in group C (14.1 ± 0.06d) (P <0.01). The total complication rate in group T was significantly lower than that in group C Statistics show that the 1-year and 3-year survival rates of patients in group T are significantly higher than those in group C (P <0.01). Conclusion: Ultrasound hepatectomy provides a new approach for the resection of hepatic hilar tumors, large hepatocellular carcinoma, especially the large vessels or bile duct due to the selective exposure of intrahepatic duct tissue.