循肝中静脉精准半肝切除疗效的前瞻性研究  

Precise hemihepatectomy guided by middle hepatic vein： a prospective study

作　　者：仇毓东[1] 朱新华[1] 朱日祥[1] 汪洋[1] 周铁[1] 陈晶[1] 周建新[1] 

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,210008

出　　处：《中华消化外科杂志》2011年第4期256-259,共4页Chinese Journal of Digestive Surgery

摘　　要：目的探讨循肝中静脉精准半肝切除术的疗效及术前肝静脉评估的应用价值。方法前瞻性非随机对照分析2007年10月至2009年9月南京大学医学院附属鼓楼医院收治的68例行半肝切除术患者的临床资料。其中循肝中静脉的精准半肝切除术30例（精准组），传统解剖性半肝切除术38例（传统组）。术前对精准组患者肝静脉进行评估分型。比较两组患者手术时间、术中出血量、输血量、肝功能、并发症发生率、住院时间等指标。计量资料采用t检验或秩和检验，计数资料采用X^2和Fisher确切概率法进行分析。结果精准组术前肝静脉评估Nakamura分型：Ⅰ型57％（17／30）、Ⅱ型27％（8／30）、Ⅲ型16％（5／30）；Kawasaki分型：Ⅰ型37％（11／30）、Ⅱ型63％（19／30）；保留肝中静脉右半肝切除13例、左半肝切除15例；不保留肝中静脉左半肝及右半肝切除各1例。精准组术中出血量、输血量、术后第3天ALT、TBil、胆碱酯酶、总住院时间、术后住院时间与传统组比较，差异无统计学意义（t=1．07，0．92，0．07，0．21，0．63，0．63，0．75，P〉0．05）。精准组和传统组患者手术时间、术后第3天Alb、并发症发生率分别为（342±113）min、（35±3）g／L、40％（12／30）和（270±73）min、（33±3）g／L、66％（25／38），两组比较，差异有统计学意义（t=2．79，2．19，）（2=4．49，P〈0．05）。精准组和传统组肿瘤标本切缘阳性率分别为5％（1／19）和35％（8／23），两组比较，差异有统计学意义（P〈0．05）。结论术前通过肝静脉评估和分型，术中循肝中静脉的精准半肝切除可最大限度保留有完整静脉回流的功能性肝脏组织，保证合适的切缘，降低术后并发症发生率。Objective To investigate the efficacy of precise hemihepatectomy guided by middle hepatic vein （MHV）, and to study the value of preoperative hepatic vein evaluation. Methods The clinical data of 68 patients who received hemihepatectomy at the Nanjing Drum Tower Hospital from October 2007 to September 2009 were prospectively studied. Of the 68 patients, 30 received precise hemihepatectomy guided by MHV （precise group） and 38 received anatomical hemlhepatectomy （traditional group）. The types of hepatic vein in the precise group were evaluated and classified preoperatively. The operation time, operative blood loss, volume of blood transfusion, liver function, morbidity and length of hospital stay of the 2 groups were compared. All data were analyzed using the t test, rank sum test, chi-square test and Fisher exact probability. Results According to the Nakamura＇s classification, there were 17 （57%） patients with type Ⅰ , 8 （27%） with type Ⅱ and 5 （ 16% ） with type Ⅲ; according to the Kawasaki＇s classification, there were 11 patients with type Ⅰ （37%） and 19 with type Ⅱ （63%）. There were 13 patients received right hepatectomy with MHV preservation, 15 received left hepatectomy with MHV preservation, 1 received fight hepatectomy without MHV preservation and 1 received left hepatectomy without MHV preservation. There were no significant difference in the volume of operative blood loss and blood transfusion, level of alanine transaminase, total bilimbin, cholinesterase at postoperative day 3, total length of hospital stay and length of postoperative hospital stay between the 2 groups （ t = 1.07,0.92, 0.07, 0.21, O. 63, 0. 63, O. 75, P 〉 0.05）. The operation time, levels of albumin at postoperative day 3 and complication rate were （342 ± 113）minutes, （35 ±3）g/L and 40% （12/30） in the precise group, and （270 ±73）minutes, （33 ±3）g/L and 66% （25/38） in the traditional group, respectively, with significant differences between the 2 groups （t = 2

关 键 词：精准肝切除 肝静脉分型 肝中静脉 术前评估 

分 类 号：R657.3[医药卫生—外科学]