肝三叶切除术手术体会及围手术期处理(附30例报道)  

ULTIMATE HEPATECTOMY:DECISION,PERIOPERATIVE MANAGEMENT AND OUTCOME

作　　者：徐峰[1] 黄杨卿[1] 杨甲梅[1] 隋承军[1] 张敏峰[1] 

机构地区：[1]上海东方肝胆外科医院,上海200438

出　　处：《肝胆外科杂志》2012年第2期93-95,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝三叶切除的手术技巧和围手术期处理。方法 2008年10月至2010年6月成功实施30例肝三叶切除术。30例中28例为原发性肝癌,23例合并肝炎后肝硬化,2例巨大海绵状血管瘤。术前肝功能均为Child-Pugh A级。右三叶切除22例,左三叶切除8例。结果无手术死亡。术中中位出血量:2148.42 mL(220～6000 mL);中位输血量:2126.32 mL(0～8500 mL)。术后平均住院天数:11.26+2.58天(8～17天)。术后并发症:1例发生术后腹腔出血,再次入腹止血。无1例发生肝功能衰竭。胆漏2例,经引流后均短期愈合。结论肝三叶切除术应严格掌握适应证,并完善和认真执行围手术期处理,才能减少相关术后并发症的发生,提高手术安全性。Objective Ultimate hepatectomy（trihepatectomy） is a high-risk surgical operation with high mortality and high rate of complication.Therefore,we should carefully make decision for such operation.When and how to perform ultimate hepatectomy is our focus of this study.Methods 30 patients accepted ultimate hepatectomy from Oct.2008 to Jun.2010.There were 28 hepatocellular carcinoma with 23 liver cirrhosis caused by viral hepatitis and 2 hemangioma among these patients.All the patients had an A grade of Child-Pugh score.Right trihepatectomy ware performed in 22 patients and 8 were left trihepatectomy.Results Median bleeding volum was 2148.42 mL（220～6 000 mL）;median blood transfusion volum was 2126.32 mL（0～8 500 mL）.Mean postoperative hospital stay was 11.26＋2.58d（8～17 d）.No death and serious complication such as liver failure occurred.Main complications were postoperative bleeding（1 case） and bile leakage（2 cases）.Conclusions Although ultimate hepatectomy is a high-risk operation,satisfied outcome would be acquired with serious selection of patient,well-versed liver resection skill and sufficient perioperative management.

关 键 词：肝切除术 极量肝切除 肝三叶切除 原发性肝癌 肝血管瘤 

分 类 号：R575[医药卫生—消化系统]