选择性肝血流阻断解剖性肝Ⅵ、Ⅶ、Ⅷ段切除术  

Anatomical multiple hepatic segmentectomy by selective occlusion of hepatic inflow for the treatment of primary hepatic cancer

作　　者：贾长库[1] 陈有科[1] 符誉[1] 翁杰[1] 

机构地区：[1]海南医学院附属医院肝胆外科,海口570102

出　　处：《中华消化外科杂志》2013年第9期659-662,共4页Chinese Journal of Digestive Surgery

基　　金：海南省教育厅高校科研资助项目（Hjkj2012-25）

摘　　要：解剖性肝切除不但能够保证足够的无瘤切缘，而且还能最大限度地保留非肿瘤肝组织。2012年2月，海南医学院附属医院运用选择性肝血流阻断技术成功为1例61岁的男性多发原发性肝癌患者行解剖性肝Ⅵ、Ⅶ、Ⅷ段切除术。术前cT检查示肝Ⅵ、Ⅶ、Ⅷ段多发占位性病变，三维重建测算左半肝体积少于最小存活肝脏体积。为了最大限度保留剩余肝脏，拟行保留V段的解剖性肝Ⅵ、Ⅶ、Ⅷ段切除术。术中运用了两次Glisson蒂阻断技术，解剖出右半肝和右后叶的Glisson蒂，从而确定肝Ⅵ、Ⅶ、Ⅷ段的切除范围，完成了解剖性肝Ⅵ、Ⅶ、Ⅷ段切除。区域性的人肝血流阻断技术是减轻肝脏的缺血再灌注损伤的关键，对手术的顺利完成及患者术后恢复都至关重要。Anatomic hepatic resection not only enables enough tumor-free resection margin, but also guarantee the max- imal remnant of normal liver tissue. A 61-year-old male patient with hepatic cancer was admitted to the Affiliated Hospital of Hainan Medical College in February 2012. Multiple space-occu- pying lesions were found in segment V[, VI and VIH by computed tomography （CT）. The results of CT volumetry analysis showed that the left hemihepatic volume was lesser than the minimal lim- it of survival, so anatomic hepatic segmentectomy of VI, VII and VIU with preservation of segment V was designed to guarantee the maximal remaining of normal liver tissue. Glisson＇s pedicle tran- section was used twice to divide the right hemihepatic Glisson＇s pedicle, segment VI and VII Glisson＇s pedicle, respectivley, then the resection line was determined, and anatomical hepatic segmentectomy of VI, VII and vm was completed. With the procedures adopted, the hepatic ischemia reperfusion injury and hemodynamic instability were maximally reduced during operation.

关 键 词：肝肿瘤 肝切除术 选择性阻断 

分 类 号：R735.7[医药卫生—肿瘤]