肝三叶切除术在巨大肝癌中的应用体会(附24例报告)  

Usage of trisegmentectomy for giant liver cancer (24 cases)

作　　者：李敏[1] 张伟[1] 程南生[2] 田银生[1] 朱宇[1] 葛明刚[1] 刘勇[1] 赵剑[1] 李毅[1] 

机构地区：[1]遂宁市中心医院肝胆外科,四川遂宁629000 [2]四川大学华西医院普外科

出　　处：《中国现代医学杂志》2009年第22期3484-3486,3490,共4页China Journal of Modern Medicine

摘　　要：目的探讨肝三叶切除术在巨大肝癌中的可行性和安全性。方法从2005年1月～2008年1月,我们对24例巨大肝癌采用肝三叶切除。肝肿瘤直径11～26cm,平均15.5cm。其中合并门静脉癌栓(PVTT)14例,下腔静脉癌栓1例。术前肝功能均为CHILD A级。结果行右三叶切除17例,左三叶切除7例。其中联合胃次全切除3例,横结肠及脾切除各1例。对合并门静脉/下腔静脉癌栓者,术中同时行取栓术。累计阻断时间13～47min,平均18min。术中出血350～3100mL不等,平均650mL。本组病例围手术期无一例死亡,均痊愈出院。其中,术后生存超过12个月的18例(75%),24个月的11例(45.8%),30个月的9例(37.5%)。结论掌握手术指征和手术技巧,并作好围手术期处理,肝三叶切除术仍不失为目前巨大肝癌治疗的安全、有效的方法。[ Objective ] To explore the safty and feasibility of trisegmentectomy for giant liver cancer. [ Methods] Trisegmentectomy was performed on 24 cases of giant liver cancer with mean diameter 15.5 cm （range 11-26） from January 2005 to January 2008 and the clinical data were analysed retrospectively. Of them, 14 cases with portal vein tumor thrombi （PVTT） and 1 with IVC tumor thrombi, the preoperative liver function was graded as CHILD A. [ Resuits] 17 cases underwent right trisegmentectomy and 7 cases left trisegmentectomy, 3 cases accepted sub-gastroectomy, 1 case spleenectomy and 1 case colonectomy concurrently. Extraction was performed on cases with tumor thromb intraoperatively. Mean hepatic pedicle occulsion duration was 18 minutes （range 13-47）, and mean blood loss was 650 mL （range 350-3100）. No death occured in porioperative duration and 18 cases have survived over 12 monthes, 11 cases over 24 monthes and 9 patients have still been alive over 30 monthes postoperatively. [ Conclusion] With strict indicatio, operative skill and proper perioperative treatment, trisegmentectomy for giant liver cancer is still safe and feasible.

关 键 词：肝三叶切除术 肝癌 

分 类 号：R735.7[医药卫生—肿瘤]