腹腔镜技术在肝脏和结、直肠手术中的应用(附20例报告)

目的介绍腹腔镜在肝脏、结直肠手术中的应用。方法腹腔镜下实施肝囊肿开窗术8例,肝腺瘤切除术1例,结直癌切除术11例。结果所有病例顺利恢复,无手术并发症。结论熟练掌握腹腔镜技术,严格选择病例,腹腔镜技术在肝脏、结直肠手术中的早期应用能够达到传统手术的效果

影响中晚期肝细胞肝癌手术切除预后的多因素分析

探讨影响中晚期肝细胞肝癌手术切除预后的因素。方法对130例中晚期大肝癌随访1～7年,采用单因素、多因素分析统计不同预后因素对患者生存率的影响。结果手术后1,3 ,5年生存率分别81.7%,24.3%,18.4%。单因素分析提示影响预后的因素为肝癌大小、是否早期复发、肝硬化情况、输血量;多因素分析提示肝癌大小、肿瘤早期复发是影响肝癌术后的预后因素。结论：中晚期肝癌手术切除预后仍不理想,重视围手术期处理,预防术后早期复发有望提高手术疗效 [英文摘要]Objective To study the prognostic factors in patients who received hepatectomy for large hepatocellular carcinoma(HCC). Methods 130 patients operated for large HCC were followed up for 1～7 years. Twenty possible factors were analyzed by Kaplan-Meier Log rank estimate. A multivariative survival analysis of these individal variable was undertaken using the cumulative survival rate by the computers COX proportional hazard. Result The overall cumulative survival rate at 1,3,5 years was 81.7%,24.3%,18.4% re..

原发性肝癌并门静脉癌栓的治疗选择

目的探讨肝癌并门静脉癌栓 (PVTT)患者综合治疗的疗效。方法 5年来共收治176例肝癌合并PVTT的患者 ,手术组 32例 ,行规则或不规则肝切术并术中门静脉取癌栓 ,门静脉或肝动脉置泵术 ;介入组 14 4例 ,经肝动脉栓塞化学药物治疗。结果手术组 0 5 ,1,2年生存率分别为 94 % ,5 0 % ,19% ,术后常见并发症 :暂时性肝功能不全 4 4 % (14 / 32 ) ,右胸腔积液 31% (10 / 32 ) ,上消化道出血 2 8% (9/ 32 )等 ,无手术死亡。介入组 0 5 ,1年生存率为 35 % ,0。在介入组中 ,肝功能分级为Ⅰ的患者 34例在患者年龄 ,癌灶体积大小与手术组无明显差异 ,但其 0 5 ,1年生存率 (5 9% ,0 )显著低于手术组 (94 % ,5 0 % )。结论PVTT患者能耐受手术者应积极肝癌切除并术中取栓治疗 ,术后经门静脉 ,肝动脉泵化疗或栓塞化疗能延长部分病人的生命 ,手术治疗优与介入治疗。 【英文摘要】 ObjectiveTo evaluate the result of different therapy choice for hepatocellular carcinoma (HCC) with tumor thrombi in the main trunk or first branch of the portal vein (PVTT).Metheds HCC patients ( n =176) with PVTT were divided into hepatectomy group ( n =32) undergoing irregular or regular hepatic resection with removal of tumor thrombi in the portal vein and drug delivery system (DDS) in portal vein/hepatic artery, and TACE group ( n =144) receiving transcatheter arterial chemoembolization. Result..

改良式无血切肝术在复杂型肝细胞肝癌切除术中的应用

目的讨论无血切肝在复杂型 HCC中的价值。对象和方法收集自 1997.1- 1999.1收治的复杂型 HCC2 2例 ,统计其性别、年龄及肿瘤大小、肿瘤的侵犯程度、围手术期处理方法、术中出血和输血量、阻断时间、术后肝衰、手术死亡、术后复发和生存时间等指标。结果　肿瘤最常侵犯的大血管是门脉 ,达 45 .45 % ;平均术中出血量为 818.18± 491.5 7ml,输血量为 890 .91± 6 15 .5 6 ml,术中无血阻断的时间为 2 2 .0 0± 13.0 8(6～ 5 5 )分钟 ,手术死亡率为 9.0 9% ,1年复发率为 45 .45 % ,1年生存率为 77.2 7%。结论　改良式无血切肝法能提高复杂型 HCC的手术切除率 ,减少术中出血量和输血量 ,延长肝脏热缺血耐受时间 ,手术死亡率低 ,能有效延长晚期 HCC的生存时间 ,因而它是一种安全有效的手术方法 【英文摘要】 Objective Hepatocellular carcinoma(HCC) were the most advanced and complex.In order to improve there low resection rates and poor prognosis,we used the improved no blood hepatectomy methods.Methods From 1997.1 to 1999.1,22 cases with complex HCC were resected with improved no blood hepatectomy method in our hospital.Results The most often invasived vascular was portal vein(45.45%),vascular block time was 22.00±13.08(6-55)mins,the surgical mortality was 9.09%,the recurrent rate in 1 years was 45.45%,and..