经肝后下腔静脉前右间隙入路右半肝切除术  

Right hemihepatectomy through the right retrohepatic tunnel

作　　者：卢强[1] 覃谦[2] 

机构地区：[1]中山大学附属东华医院普通外科,东莞523110 [2]中山大学附属东华医院肿瘤外科,东莞523110

出　　处：《国际外科学杂志》2013年第4期249-251,F0003,共4页International Journal of Surgery

摘　　要：目的研究右肝巨大肿瘤患者经右侧肝后下腔静脉前间隙入路逆行解剖结扎肝短静脉和右肝静脉在右半肝切除术中的临床意义。方法对23例右肝巨大肿瘤（〉8cm×8cm）患者，依次采用切开第二肝门分离右肝静脉与中肝静脉间隙，于Glisson氏系统鞘内分离、结扎右半肝门静脉和肝动脉，随后逆行沿右侧肝后下腔静脉前间隙解剖结扎肝短静脉和右肝静脉，最后于肝中线左侧置一阻断带再离断肝中线的右半肝切除术。结果全组患者在分离右半肝动脉、门静脉、肝后下腔静脉和右肝静脉解剖的右半肝切除术中过程顺利。术中出血量：〈400mL7例，500～700mL11例，800～1000mL2例，1100—1400mL13例；平均为640mL。术后第3天肝功能变化情况：总胆红素20～40μmol／L16例，45～50μmol／L6例，60μmol／L1例。血清谷丙转氨酶150～200U／L14例，250～400U／L9例。血清谷草转氨酶160—200U／L13例，230～400U／L9例，430U／L1例。r一谷氨酰转肽酶160—200U／L14例，220～310U／L8例，420U／L1例。术后因并发深静脉细菌感染导致肝功能衰竭1例。结论肿瘤没有直接侵犯膈肌、肝后下腔静脉或肿瘤非特别巨大可选择沿肝后下腔静脉右前间隙逆行解剖结扎肝短静脉和右肝静脉的右半肝切除术方式，可以减少术中出血，有利于术后肝功能的恢复。Objective To study the clinical value of anatomizing and ligating the short hepatic veins （SHVs） and fight hepatic veins through the right Retrohepatic Tunnel （RT） in fight hemibepatectomy of giant hepatic carci- noma. Methods We performed the right hemibepatectomy on 23 patients with huge tumors which diameters were lager than 8 cm. There were four main procedures during the operation. Firstly, sperated the interspace between right hepatic veins and middle hepatic veins through secundum porta hepatis. Secondly, seperated and ligated the right hepatic portal vein and hepatic artery in the Glisson~ system. Thirdly, anatomized and ligated SHVs and right hepatic veins through the fight RT conversly. Finally, set a blocking- belt at the left of the central liver and then cut the right hemi-hepar. Results The anatomy of right hepatic artery, Portal Vein, retrohepatic inferior vena eava （RHIVC） , right hepatic veins was well done. The intraoperative blood loss of 7 patients was less than 400 mL, and 11 was 500-700 mL, 2 was 800-1 000 mL, 3 was 1 100-1 400 mL, and average was 640 mL. The hepatic function was changed in the third day afteroperation. The numerus of TBIL of 16 patients was 20-40 μmol/L, and 6 was 45-50 μmol/L,and 1 was 60 Ixmol/L. The numerus of ALT of 14 patients was 150-200 U/L, and 9 was 250- 400 U/L. The numerus of AST of of 13 patients was 160-200 U/L, and 9 was 230-400 U/L, and 1 was 430 U/L. The numerus of GGT of 14 patients was 160-200 U/L, and 8 was 220-310 U/L, and 1 was 420 U/L. The hepatic failure happened to 1 patient because of deep venous infection. Conclusions The right hemibepateetomy through the fight retrohepatic tunnel is feasible in the tumor without invasion the RHIVC and diaphragm, or the volume was not too huge. The operation could reduce the blood loss and make for the recovery of hepatic funtions.

关 键 词：肝肿瘤 肝后下腔静脉前间隙 血管结扎 肝切除术 治疗 临床研究性 

分 类 号：R657.3[医药卫生—外科学]