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肝切除术20年回顾:单一中心连续2008例肝切除术的经验

Liver resection: single center experiences of 2008 consecutive resections in 20 years

摘要:

目的 分析与肝切除术相关的手术期和围手术期因素.方法 回顾性研究和分析解放军总医院1986至2005年2008例连续性肝切除手术病例的临床资料.结果 2008例肝切除病例中恶性肿瘤占58.5%,其中原发性肝癌占76.1%,肝门胆管癌占6.7%;良性疾病占41.2%,其中血管瘤占41.7%,肝内胆管结石占29.6%.实施单独尾状叶切除术25例,微波在线预凝肝切除术236例.全部肝切除病例术中出血量<200 ml者占50.5%,>400 ml者占28.4%;而微波在线预凝肝切除术中出血量<200 ml者占60.6%,>400 ml者占19.9%,两数值均明显区别于全部肝切除病例(P<0.05).总的术后并发症发生率为14.44%,转移性肝癌为16.40%,肝内胆管结石为16.32%;原发性肝癌的术后并发症发生率为12.54%,其中小肝癌和巨大肝癌分别为11.65%和14.69%,二者差异无统计学意义.总的住院病死率为0.55%,其中肝恶性肿瘤住院病死率为0.60%,肝门胆管癌为2.53%.结论 在重视优化围手术期处理和创新手术技术的前提下,能够使肝切除术保持低并发症发生率和低病死率.

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abstracts:

Objective To analyze operative and perioperative factors associated with hepatectomy.Methods 2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation.Diagnoses were made on basis of pathological results.Results Malignant and benign liver diseases accounted for 58.5% and 41.2% ,respectively.In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%.Hemangioma(41.7% ) and bepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios.Isolated candate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection.In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008),whereas those with more than 400 ml accounted for 28.4% (570/2008).In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236),respectively,which differed significantly from the average level (P <0.05).The postoperative complication incidence was 14.44% for all cases,12.54% for primary liver cancer,16.40% for secondary liver cancer, and 16.32% for bepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%.There was no significant difference between the two groups.All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%,hilar cholangiocarcinoma 2.53%.Conclusion Hepatecctomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.

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作者: 黄志强 [1] 徐立宁 [1] 杨滔 [1] 张文智 [1] 黄晓强 [1] 刘荣 [1] 蔡守旺 [1] 张爱群 [1] 冯玉泉 [1] 周宁新 [1] 董家鸿 [1]
第一作者: 黄志强
期刊: 《中华外科杂志》2008年46卷17期 1314-1321页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 论著
DOI: 10.3321/j.issn:0529-5815.2008.17.010
发布时间: 2008-12-08
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