绕肝提拉法在联合肝脏离断和门静脉切断二步肝切除术中的应用  

Application of liver hanging maneuver in associating liver partition and portal vein ligation for staged hepatectomy

作　　者：王志明[1] 胡宽[1] 苌群刚 黄云[1] 周乐杜[1] 李新营[1] 李劲东[1] 陶一明[1] 

机构地区：[1]中南大学湘雅医院普通外科,湖南长沙410008

出　　处：《中国普通外科杂志》2015年第1期12-17,共6页China Journal of General Surgery

基　　金：国家自然科学基金面上项目(81372630;81372631);中南大学湘雅医院2014年度临床科研基金资助项目(2014L07)

摘　　要：目的：探讨绕肝提拉法（LHM）在联合肝脏离断和门静脉切断二步肝切除术（ALPPS）中的应用效果。方法：回顾性分析4例原发性肝细胞癌行ALPPS术患者临床资料,其中肝右叶肿瘤3例,肝尾状叶肿瘤1例,均采用LHM法导引的一期左、右肝脏原位劈离,右门静脉切断;二期行肿瘤完整切除。结果：4例均预先游离肝脏,成功安置弹力带,顺利实施二期肝切除术;一期手术时间195~273（232.2±35.3）min,术中失血420~1 210（735±344.3）m L,并发胆瘘1例;二期手术时间98~186（139.5±36.6）min,术中失血100~320（197.5±95.3）m L;无手术死亡;术后随访3个月,3例情况良好,1例术后2个月复发死亡。结论：LHM法对于下腔静脉的保护,充分显露左右肝动脉、肝静脉、肝内胆管有较好的效果,可常规适用于肝肿瘤ALPPS二步肝切除术。Objective： To investigate the effcacy of using liver hanging maneuver（LHM） in associating liver partition and portal vein ligation for staged hepatectomy（ALPPS）. Methods： The clinical data of 4 patients with primary liver cancer undergoing ALPPS procedure were retrospectively analyzed. Of the patients, 3 cases had tumor in the right lobe and one case in the caudate lobe. All patients underwent i rst-stage operation of in situ split ing of the liver parenchyma and right portal vein ligation guided by LHM, and a second-stage of complete tumor removal. Results： In all the 4 patients, the prior hepatic transection, hanging tape positioning and second-stage liver resection were performed successfully. In the first-stage operation, the operative time was 195–273（232.2±35.3） min, intraoperative blood loss was 420–1 210（735±344.3） m L, and bile leakage occurred in one case; in the secondstage operation, the operative time was 98–186（139.5±36.6） min, and intraoperative blood loss was 100–320（197.5±95.3） m L. No operative death occurred. The patients were followed-up for 3 months, at which time 3 patients were in good condition, and one patient had died of recurrence 2 months at er operation.Conclusion： LHM is effective for inferior vena cava protection and clear exposure of the intrahepatic blood vessels and ductal system, so it can be routinely used in ALPPS procedure.

关 键 词：肝肿瘤 肝切除术 绕肝提拉法 

分 类 号：R735.7[医药卫生—肿瘤]