手术治疗侵犯第二、三肝门占位性病变13例分析  

Surgical resection of liver masses involving the second and the third porta hepatis: a report of 13 cases

作　　者：李嘉鑫 吴泓[1] 陈哲宇[1] 曾勇[1] 

机构地区：[1]四川大学华西医院肝脏外科,成都610041

出　　处：《中国普外基础与临床杂志》2017年第9期1057-1061,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结手术治疗侵犯第二、三肝门占位性病变的手术技巧和适应证。方法回顾性分析四川大学华西医院于2013年6月至2016年9月期间收治的13例累及第二、三肝门占位性病变患者的临床病理学资料。结果 13例患者中,肝泡球蚴3例,肝细胞癌4例,胆管细胞癌4例,结肠癌肝转移2例;包块直径7~21 cm,平均12.5 cm。所有患者术前行影像学检查均发现肝后下腔静脉或肝静脉根部受压。13例患者中,行右三肝切除7例,左三肝切除1例,右半肝切除4例,左半肝切除1例,其中加行尾叶切除9例。所有患者的肝脏包块均成功切除,手术顺利,无围手术期死亡。手术时间为210~450 min,平均313 min;术中出血量为300~1 100 m L,平均592 m L;术中输血4例,输血量为300~450 m L,平均338 m L;全肝血流阻断时间为25~55 min,平均42 min;5例行下腔静脉重建,1例行肝静脉重建。术后发生腹水6例,胸水6例,肝功能衰竭2例,胆汁漏2例,肺部感染3例,下肢静脉血栓1例。术后住院时间为7~20 d,平均10 d。术后13例患者获访,随访时间为1~39个月,中位数为14个月。随访期间死亡4例(胆管细胞癌3例,结肠癌肝转移1例)。结论对于侵犯第二、三肝门的占位性病变,通过详细的术前评估和准备,术中熟练应用血管重建技术和切肝技巧,可取得较好的效果。Objective i To summarize the surgical technique and indications for liver masses involving the second and the third porta hepatis. Methods Thirteen cases of liver mass involving the second and the third porta hepatis, who underwent surgery in West China Hospital of Sichuan University from June 2013 to September 2016 were collected retrospectively, then made a statistical analysis, including patients＇ information, characteristics of liver masses, operation information, and result of foUowed-up. Results Of the 13 cases, there were 3 cases of hepatic alveolar echinococcosis, 4 cases of hepatocellular carcinoma, 4 cases of intrahepatic cholangiocarcinoma, and 2 cases of liver metastasis induced by colon cancer. The mean tumor diameter was 12.5 cm （7-21 cm）. Preoperative imaging examinations showed that mass had involved the second and the third porta hepatis, and all masses were resected by surgery without perioperative death, including 7 cases of right three hepatectomy resection, 1 case of left three hepatectomy resection, 4 cases of right hepatectomy resection, and 1 case of left hemi hepatectomy resection; among them, 9 cases were performed caudal lobectomy resection. The mean of operative time was 313 min （210-450 min）, the mean ofintraoperative blood loss was 592 mL （300-1 100 mL）. Four cases received blood transfusion with 300-450 mL （mean of 338 mL）. The total hepatic blood inflow occlusion time was 25-55 min （mean of 42 min）. Five cases received venous reconstruction, and 1 case received hepatic vein reconstruction. After operation, ascites occurred in 6 cases, pleural effusion occurred in 6 cases, liver failure occurred in 2 cases, bile leakage occurred in 2 cases, pulmonary infection occurred in 3 cases, deep vein thrombosis occurred in 1 case. All of the 13 cases were fullowed-up for 1-39 months （median time was 14 months）, during the followed-up period, 4 cases died, including 3 cases of intrahepatic cholangiocarcinoma and 1 case of liver metastasis induced by colon cancer. Conc

关 键 词：第二肝门 第三肝门 肝肿瘤 肝包虫病 血管重建 手术 

分 类 号：R657.3[医药卫生—外科学]