肝三叶切除术治疗肝脏巨大肿瘤29例  

Hepatic trisegmentectomy for 29 patients with huge neoplasms of liver

作　　者：芮静安[1] 王少斌[1] 陈曙光[1] 周立[1] 魏学[1] 韩凯[1] 张宁[1] 赵海涛[1] 杨欣[1] 

机构地区：[1]北京大学第八临床医学院

出　　处：《中华外科杂志》2001年第10期759-761,共3页Chinese Journal of Surgery

摘　　要：目的　探讨肝三叶切除术治疗肝脏巨大肿瘤的可行性及疗效。　方法　自 1993年 7月～ 1999年 10月间行肝三叶切除术治疗肝脏巨大肿瘤 2 9例 ,其中包括原发性肝癌 2 3例 ,胆囊癌肝浸润、结肠癌肝转移、肝血管肉瘤和肝神经纤维瘤各 1例及肝巨大囊肿 2例。共行肝右三叶切除术 2 6例 ,肝左三叶切除术 3例。所有手术均采用常温下一次性肝门阻断法 ,阻断时间为 15～ 40min。　结果　本组肝三叶切除术取得较好疗效 ,原发性肝癌患者的 1、3、5年生存率分别为 6 3 6 %、36 4%和2 7 3% ,胆囊癌肝浸润和结肠癌肝转移患者的生存期均为 6个月 ,肝血管肉瘤、肝神经纤维瘤和 2例肝巨大囊肿患者至最近随访止已分别生存 35、2 6、2 5和 40个月。 5例出现明显的并发症 ,手术病死率为 3 4% (1 2 9)。　结论　如能掌握好手术适应证 (肝储备功能好 )和手术技巧 (肝门阻断技术 ) ,肝三叶切除术治疗肝脏巨大肿瘤是安全和有效的。Objective To evaluate the feasi bi lity and effect of hepatic trisegmentectomy for patients with huge neoplasms of liver. Methods From July 1993 to October 1999, 29 patients with huge hepatic neoplasms underwent hepatic trisegmentectomy, (2 3 patients with primary liver cancer, 1 patient with hepatic infiltration of gal lbladder cancer, 1 patient with metastasis of colon cancer, 1 patient with hepat ic angiosarcoma, 1 patient with hepatic neurofibroma, and 2 patients with huge liver cyst). Of these patients, 26 underwent right trisegmentectomies and th e rest 3 accepted left trisegmentectomies. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these i nterruptions lasted 15 to 40 minutes. Results The relatively good effect was seen in our series of trisegmentectomies. The 1- , 3-, 5-year survival rates for patients with primary liver cancer were 636% , 364% and 273%, respectively. The survival time for patients with hepatic i nfiltration of gallbladder cancer and metastasis of colon cancer in the liver wa s 6 months. The patients with hepatic angiosarcoma, hepatic neurofibroma and 2 huge liver cysts survived 35, 26, 25, 40 months and 1 till to the latest follow -up, respectively. Main complications were present in 5 patients. Mortality wit hin 1 month was 34% (1/29). Conclusion Hepat ic trisegmentectomy is safe and effective in treatment of huge hepatic neoplasms if its indications and operative techniques are mastered properly.

关 键 词：肝肿瘤 肝切除术 存活率 可行性 疗效 肝三叶切除术 

分 类 号：R735.7[医药卫生—肿瘤] R730.56[医药卫生—临床医学]