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目的：探讨微波固化在肝硬化肝癌不规则性肝切除术中的应用价值。方法：回顾性分析第四军医大学唐都医院普外科2011 年1 月-2013 年4 月行不规则性肝切除肝硬化肝癌患者158 例的临床资料，其中男性96 例，女性62 例，年龄32-65 岁（47.7± 9.4）。乙型肝炎后肝硬化58 例，酒精性肝硬化21 例。肝功能分级：Child-Pugh A级116 例，B 级42 例。不规则性肝切除组（Ⅰ组） 77 例，微波固化+ 不规则性肝切除组（Ⅱ组）81 例，两组在性别构成、年龄、肝炎病史、肝癌病史、门静脉高压症、AFP、PLT、 Child-Pugh 评分、肝功能（白蛋白、谷丙转氨酶、总胆红素、凝血酶原时间）等无显著差异（P>0.05）。比较分析两组术中肝门阻断、出血量、输血量、手术时间、术后肝功能恢复及术后并发症的发生率情况。结果：微波固化+ 不规则性肝切除术组无肝门阻断，且在手术时间、出血量、补血量、补液量、住院时间、术后住院时间明显少于不规则性肝切除术组（P<0.05）。而在淋巴结清扫数目、围手术期死亡率无显著差异（P>0.05）。在术后1 天、3 天和7 天时，两组在白蛋白、总胆红素、凝血时间无显著差异（P>0.05），术后1 天、 3 天谷丙转氨酶无显著差异（P>0.05），术后7天时Ⅱ组较Ⅰ组恢复快（P<0.05）。Ⅱ组术后并发症发生率明显少于Ⅰ组。结论：微波固化在不规则性肝切除术中无需行肝门阻断，具有出血少、输血少、手术时间短、术后住院时间短等优点。微波固化联合不规则性肝切除术在肝硬化肝癌中具有良好效果。

英文摘要:

Objective:To investigate the value of microwave coagulation therapy in the irregular hepatectomy of patients of hepatic carcinoma with liver cirrhosis.Methods:The clinical data of 158 patients diagnosed as hepatic carcinoma with liver cirrhosis who underwent irregular hepatectomy from January 2011 to April 2013 were retrospectively analyzed. There were 96 male and 62 female patients, from32 years to 65 years, with an average age of (47.7± 9.4) years. There were 58 cases of liver cirrhosis after hepatitis B, and 21 cases of alcoholic liver cirrhosis. Liver function grade: Child-pugh A: 116 cases, Child-pugh B: 42 cases. Irregular liver resection (Ⅰ group ) 77 cases, microwave coagulation therapy and irregular liver resection (Ⅱ group ) 81 cases, there was no significant difference in gender, age, history of hepatitis, history of hepatic carcinoma, portal hyportension, AFP, PLT, Child-Pugh score, liver function ( albumin, alanine aminotransferase, total billirubin, prothrombin time), etc (P>0.05). To compare and analyze hepatic portal occlusion, blood loss, blood transfusion volume, operation time, recovery of postoperative liver function and the incidence of postoperative complications between the two groups in the operation.Results:Comparing to Ⅰgroup, there was no hepatic portal occlusion in Ⅱ group, and operation time, blood loss, blood transfusion volume, fluid infusion volume, hospital stays, postoperative hospital stays were less (P<0.05). But there was no significant difference in lymph nodes dissected and perioperative mortality between the two groups. There was no significant difference in albumin, total billirubin and prothrombin time at 1 day, 3 days and 7 days postoperative (P>0.05). There was no significant difference in alanine aminotransferase at 1 day and 3 days postoperative between the two groups (P>0.05), and Ⅱ group recovered more quickly than Ⅰ group in alanine aminotransferase at 7 days postoperative (P<0.05). Ⅱ group was obviously less than Ⅰ group in incidence of complications postoperative (P<0.05).Conclusion:Application of microwave coagulation therapy in the irregular hepatectomy of Patients of hepatic carcinoma with liver cirrhosis is not need to make hepatic portal occlusion, and has the virture of less bleeding, less blood transfusion, shorter operation time and shorter postoperative hospitalization time.Microwave coagulation therapy and irregular hepatectomy have a good effect in patients of hepatic carcinoma with liver cirrhosis.

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