中肝叶切除术治疗中央型肝肿瘤：九例报告并系统综述  

Mesohepatectomy for treatment of centrally located liver tumors： a report of 9 cases and systematic literature review

作　　者：李志民[1] 杨甲梅[2] 李滨[1] 许东辉[1] 苏旭[1] 周彦明[1] 

机构地区：[1]福建医科大学附属厦门第一医院肝胆胰血管外科,厦门361003 [2]第二军医大学东方肝胆外科医院特需科,上海200438

出　　处：《中华肝胆外科杂志》2010年第12期900-902,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 评价中肝叶切除术治疗中央型肝肿瘤的安全性和疗效.方法 9例报告并系统性综述中肝叶切除术治疗中央型肝肿瘤的中英文文献.结果 9例病人围手术期病死率和并发症的发生率分别为0%和66.6%,在3～38个月的随访期间,8例病人存活.系统性综述共纳入20项临床试验,其中4项为比较中肝叶切除术与肝叶切除或扩大半肝切除术的回顾性非随机对照研究.中肝叶切除术外科病死率为0%～7.4%,常见的并发症有：胆漏（0.4%～18.5%）、胸腔积液（5.7%～23.5%）、腹水（1.9%～11.6%）和肺炎（1.7%～2.5%）.4项非随机研究结果均显示中肝叶切除术组与肝叶切除或扩大的半肝切除术组之间围手术期病死率和早期术后并发症无显著差异.其中2项研究显示两组间肝细胞癌病人的平均生存期和无瘤生存率相似.结论 中肝叶切除术治疗中央型肝肿瘤安全、有效.Objective To evaluate the safety and efficacy of mesohepatectomy for treating centrally located liver tumors. Methods The clinical data of 9 cases of centrally located liver tumor treated in our hospital with mesohepatectomy were retrospectively analyzed. Meanwhile, previous reports in Chinese and English on mesohepatectomy for treating centrally located liver tumors were reviewed.Results In the current series, perioperative mortality and morbidity rates were 0 and 66.6%, respectively. Eight patients were alive during a follow-up of 3-38 months. Twenty clinical trials were included in our systematic review. Four were retrospective non-randomized trials comparing central hepatectomy with lobar or extended hepatectomy. The surgical mortality rate of mesohepatectomy was 0% ～7. 4 %. Frequent complications were bile leakage （0. 4% ～ 18. 5 % ）, pleural effusion （5. 7 % ～ 23.5 % ）, ascites （ 1.9 % ～ 11.6 % ） and pneumonia （ 1.7 % ～ 12.5 % ）. No differences in perioperative morbidity and early complication rate were found between the mesohepatectomy group and lobar or extended hepatectomy group in all four non-randomized studies. Two studies revealed that the overall survival rate and disease-free survival of patients with hepatocellular carcinoma were similar between the 2 groups. Conclusion Mesohepatectomy is a safe and effective operative procedure for the treatment of centrally located liver tumors.

关 键 词：肝肿瘤 中肝叶切除术 中央型 

分 类 号：R686[医药卫生—骨科学]