中央型巨大肝癌的手术切除及疗效观察  

Surgical treatment for the giant hepatic carcinomas occupying the central part of the liver

作　　者：王义[1] 陈汉[1] 吴孟超[1] 孙延富[1] 尉公田[1] 林川[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外二科,上海200438

出　　处：《中华外科杂志》2004年第17期1025-1028,共4页Chinese Journal of Surgery

摘　　要：目的　探讨中央型巨大肝癌手术切除的方法和疗效。方法　回顾性分析 1995年以来所切除的直径 >10cm的中央型巨大肝癌病例 ,包括位于左内、右前和全尾叶的肝细胞癌、胆管细胞癌及转移性肝癌。结果　共切除同时累及第一、二、三肝门的中央型巨大肝癌 4 0例 ,肿瘤直径平均为13 6 (10 5～ 19 0 )cm ;肝切除术式包括扩大中肝叶切除 9例 ,不规则中肝叶切除 13例 ,扩大左半肝切除 13例 ,全尾叶加扩大左半肝切除 3例 ,扩大右半肝切除 2例 ;平均手术时间为 197(90～ 380 )min ,平均手术失血量为 15 96 (30 0～ 110 0 0 )ml,全组无手术死亡 ,发生明显并发症者 8例 (2 0 % ) ;随访全组病例术后 1、3、5年生存率分别为 88%、5 6 %和 2 8%。结论　巨大中央型肝癌多同时累及 3个肝门 ,手术切除较为困难 。Objective To evaluate the techniques and the effects of surgical resection of giant hepatic carcinomas which occupied the central part of the liver Methods A retrospective study was carried out of hepatectomies performed for central giant hepatic carcinomas The hepatic tumors included in this study were hepatocellular carcinomas,cholangiocarcinomas and hepatic metastases which situated in the central part of the liver (segment Ⅳ,Ⅴ,Ⅷ,Ⅰ) with a diameter of larger than 10 cm and involved hepatocaval confluence,retrohepatic inferior vena cava (IVC) as well as hepatic portal Results A total of 40 central giant hepatic carcinomas were successfully resected,with a mean diameter of 13 6 cm (range 10 5-19 0 cm) The types of the hepatectomies conducted were as follows: extended midheptectomy in 9 cases,atypical midhepatectomy in 13 cases,extended left hepatectomy in 13 cases,total caudatectomy plus extended left hepatectomy in 3 cases and extended right hepatectomy in 2 cases The mean operation time was 197 min (range 90-380 min) and the mean intraoperative blood lose 1 596 ml (range 300-11 000 ml),with operative mortality and morbidity being 0 and 20%,respectively The postoperative 1,3 and 5 year survival rates for the patients were 88%,56% and 28%, respectively Conclusions The hepatic carcinomas of central type, when larger than 10 cm in diameter,frequently involves all the hepatic portal,hepatocaval confluence and retrohepatic IVC Surgical resection of this kind of tumor,though sophisticated in technique,is safe and effective and,therefore,the first choice of the treatments

关 键 词：巨大 中央型 大肝癌 手术切除 肝切除 肝门 肝叶切除 

分 类 号：R735.7[医药卫生—肿瘤]