肝三叶切除治疗巨大肝肿瘤  

Trisegmentectomy for Giant Hepatic Tumor

作　　者：张绍庚[1] 魏炜明[1] 陈永标[1] 谈景旺[1] 程俊波[1] 江艺[1] 林华[1] 

机构地区：[1]南京军区福州总医院

出　　处：《中国现代手术学杂志》2005年第4期265-267,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨肝三叶切除治疗巨大肝肿瘤的安全性和可行性。方法对21例平均直径15.7(12～36)cm的巨大肝肿瘤,其中包括原发性肝癌15例,肝平滑肌肉瘤1例,肝海绵状血管瘤5例,在入肝血流阻断下行肝肿瘤切除。结果21例肿瘤均得以顺利切除,行肝右三叶切除术14例,肝左三叶切除术7例。切除肿瘤重量平均2010(1230～6725)g,平均出血量980(150～4000)ml,入肝血流平均阻断时间23(12～63)min,其中入肝血流阻断1次者16例(76.2%),2次者5例(23.8%)。术后所有病人均出现一过性肝功能损害,1例(4.8%)发生肝功能衰竭于术后19d死亡,13例(61.9%)有一过性腹水,7例(33.3%)右侧胸腔积液,均经进一步处理后恢复顺利。20例获随访,14例原发性肝癌患者1、2、3、5年生存率分别为57.1%、35.7%、28.6%和7.1%,1例肝平滑肌肉瘤患者术后生存29个月,死于肿瘤复发及广泛转移,5例肝血管瘤患者术后均健康生存。结论肝三叶切除术难度大,但只要术前正确评估,术中方法得当,肝脏储备功能良好,围手术期处理适宜,仍是安全可行的。Objective To investigate the risk and feasibility of trisegmentectomy for giant hepatic tumor. Method Twenty one cases of giant hepatic tumor with mean diameter of 15.7 （ 12 ～ 36） cm, including primary hepatic carcinoma in 15 cases, hepatic leiomyosarcoma in 1 case and hepatic cavernous hemangioma in 5 cases, underwent hepatic resection under inflow occlusion. Results All the tumors had been resected successfully, including right trisegmentectomy in 14 cases and left trisegmentectomy in 7 cases. The average weight of resected specimen was 2 010（ 1 230 ～ 6 725 ） g, mean blood loss was 980（ 150 ～ 4 000） ml, mean hepatic pedicle occlusion duration was 23 （ 12 ～63 ） min including single occlusion in 16 cases（76.2% ） , twice occlusion in 5 cases（23.8% ）. All cases experienced transient hepatic functional damage except 1 case （4.8%） died of hepatic failure in the postoperative day 19, 13 cases（61.9% ） experienced transient ascites, 7 cases（33.3% ） had right thoracic cavity dropsy and resolved with conservative treatment. According to the follow-up completed in 20 cases, the 1-, 2-, 3-, and 5-year survival rate was 57.1% , 35.7% , 28.6% and 7.1% , respectively. The leiomyosarcoma case survived for 29 months and died of extensive metastasis. Five hepatic cavernous hemangioma survived disease-freely up to date. Conclusions Despite of the technical challenging, the trisegmentectomy can be safe and applicable. But the trisegmentectomy should be performed with meticulous maneuver and fair hepatic functional preservation and optimal perioperative treatment.

关 键 词：肝肿瘤 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]