肝区域血流选择性适时阻断在肝中央型大肿瘤切除中的应用  

Application of selective and timely regional hepatic vascular occlusion for resection of large centrally located liver tumors： report of 133 cases

作　　者：吴健雄[1] 王黎明[1] 刘立国[1] 钟宇新[1] 荣维淇[1] 吴凡[1] 徐泉[1] 王一澎[1] 苗成利[1] 余微波[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤研究所肿瘤医院腹部外科,100021

出　　处：《中华肿瘤杂志》2012年第11期850-854,共5页Chinese Journal of Oncology

摘　　要：目的提高肝中央型大肿瘤的切除率及手术安全性。方法采用肝区域血流选择性适时阻断技术对133例肝中央型大肿瘤患者行肝中央型大肿瘤或肝段切除。结果133例肿瘤均予完整切除，手术死亡1例。术中44例肝区域血流一次性全阻断12-33min；23例左、右肝血流分别阻断一次者，共阻断8—50min；一次右侧入肝血流阻断最长者40min。132例患者的术中出血量为（665．4±24）ml，其中94例肝原发癌合并肝硬化患者的术中出血量为（723±479）ml，38例无肝硬化患者的术中出血量为（458-223）ml，差异有统计学意义（P〈0．01）。132例患者中，有122例（92．4％）患者于术后1周内肝功能恢复至ChildA级，术后无肝功能衰竭发生。术后有3例患者出现腹水，其中2例并发肝细胞性黄疸（均为肝细胞肝癌合并肝硬化），1例术前做肝动脉介入治疗2次。术后发生胆瘘4例，胃瘫1例，门静脉及肠系膜上静脉血栓1例，右侧胸腔积液5例。112例原发性肝癌患者的1、3、5年生存率分别为89．1％、57．7％和36．9％。结论在肝中央型大肿瘤手术中，采用肝区域血流选择性、适时阻断技术能有效地控制切肝时的出血量，最大限度地减少肝组织缺血、缺氧时间，有利于保护肝细胞功能，患者术后肝功能恢复快，是一种安全的肝血流阻断方法。Objective To improve the resection rate and increase operation safety for large centrally located liver tumors. Methods Clinical data from 133 patients with large centrally located liver tumors confirmed by surgery were analyzed retrospectively. Selective and timely regional hepatic vascular occlusion was used during the operation procedure. Results The resection rate was 100%. Perioperative death occurred in one patient. During operations, Forty-four patients underwent regional hepatic inflow occlusion ranging from 12 to 33 minutes. Twenty-three patients underwent left and right inflow occlusion, respectively, ranging from 8 to 50 minutes. One patient had right half-hepatic vascular exclusion for 40 minutes. The blood loss of 132 patients was （665 ±424） ml （one patient experienced diffuse blood oozing and died in the next day）. Among them, the blood loss of patients with liver cirrhosis was （723 ±479） ml. On the contrary, those without liver cirrhosis was （458 ±223） ml （P 〈0. 01）. Liver function in 92. 4% （122/132） patients recovered to Child-Pugh A within one week. No liver failure occurred. After operation, 3 patients presented ascites. Among them, two patients had liver cirrhosis and hepatocellular jaundice, one patient was accepted for transeatheter arterial ehemoembolization preoperatively. Four patients had biliary fistula, one patient had gastreparesis, one patient had thrombus in the superior mesenteric vein and portal vein, and five patients had right pleural effusion. The 1-, 3- and 5-year survival rates of 112 patients were 89. 1% ,57.7% and 36.9%, respectively. Conclusions Selective and timely regional hepatic vascular occlusion is useful for the resection of large centrally located liver tumors. This kind of procedure can effectively control the blood loss during the operation and shorten the ischemic reperfusion time, beneficial for protecting the liver cell function. This procedure is a safe hepatic flow occlusion method.

关 键 词：肝肿瘤 肝切除术 肝区域性适时血流阻断 外科 安全性 

分 类 号：R735.7[医药卫生—肿瘤]