探讨中央型肝占位病变“华西分型”的临床应用价值

Clinical application value of "West China Hospital Classification" for central type liver space-occupying lesions

摘要:

目的： 探讨中央型肝脏占位性病变“华西分型”的临床应用价值。方法： 回顾性分析2014年7月至2019年12月在重庆医科大学附属第一医院收治的中央型肝占位性病变行开腹肝中叶切除术186例患者临床资料。按照四川大学华西医院关于中央型肝占位性病变的“华西分型”，对每一型肝占位性病变手术时间、出血量、住院时间、并发症发生率等指标进行比较。应用SPSS 16.0统计软件进行分析，率的比较采用卡方检验；计量资料以M_d（P₂₅，P₇₅）表示，采用Kruskal-Wallis H检验。检验水准α=0.05。结果： 纳入的186例患者中，原发性肝癌120例，转移性肝癌40例，良性病变26例。按照“华西分型”，Ⅰ型55例，Ⅱ型33例，Ⅲa型36例，Ⅲb型18例，Ⅳ型44例。全组无死亡病例，术后总体并发症发生率为17.7％，术后平均住院时间为（10±4） d。Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb、Ⅳ型各型的中位手术时间分别是225 min、285 min、182 min、290 min、355 min，出血量分别是445 mL、550 mL、320 mL、600 mL、1 100 mL，输红细胞悬液分别是1.0 U、2.0 U、1.5 U、3.0 U、5.0 U。术后并发症发生率分别是7.3%、6.1%、8.3%、11.1%、27.2%。与其他四型相比，IV型具有手术时间长、术中出血量多、术后并发症发生率高等特点（均P<0.05）。结论： 术前对肝脏中央型占位性疾病进行“华西分型”诊断，有利于对每一型肝中叶切除术患者诊疗的个体化、规范化，减少患者术后并发症。

Abstract:

Objective: To explore the clinical application value of “West China Hospital Classification” for central type focal liver lesions. Methods: The clinical data of 186 patients with central type focal liver lesions were admitted to The First Affiliated Hospital of Chongqing Medical University from July 2014 to December 2019 were retrospectively analyzed. Such indicators as operative time，blood loss，length of stay，and complication rate for each type of “West China Hospital Classification” for centrally located liver lesions were compared. SPSS 16.0 statistical software was used for analysis，and chi-square test was used for comparison of the rates. The measurement data were expressed as median and quartile spacing，and Kruskal-Wallis H test was conducted. When P<0.05，there was statistical significance. Results: Of the 186 patients included，120 cases were primary liver cancer，40 cases were metastatic liver cancer and 26 were benign lesions. According to “West China Hospital Classification”，there were 55 cases of type I，33 cases of type Ⅱ，36 cases of type Ⅲa，18 cases of type Ⅲb，and 44 cases of type Ⅳ. In the whole group，there were no deaths，the overall postoperative complication rate was 17.7%，and the average postoperative hospital stay was（10±4） d. The median operation time for type Ⅰ，type Ⅱ，type IIIa，Ⅲb and type Ⅳ were 225 min，285 min，182 min，290 min，355 min respectively. The median bleeding loss for type Ⅰ and type Ⅱ，type Ⅲa，Ⅲb and type Ⅳ were 445 mL，550 mL，320 mL，600 mL，1 100 mL respectively. The median amount of red blood cell transfusion for type Ⅰ and type Ⅱ，type Ⅲa，Ⅲb and type Ⅳ were 1.0 U，2.0 U，1.5 U，3.0 U，5.0 U respectively. The incidence of postoperative complications for type Ⅰ and type Ⅱ，type Ⅲa，Ⅲb and type Ⅳ were 7.3%，6.1%，8.3%，11.1% and 27.2%，respectively. Compared with the other four types，type Ⅳ had the characteristics of long operation time，large intraoperative blood loss and high incidence of postoperative complications（all P<0.05）. Conclusion: Preoperative diagnosis of central type focal liver lesions according to “West China Hospital Classification” is beneficial to individualize and standardize for each type of mesohepatectomy and reduce postoperative complications of patients.