手术治疗侵犯第二、三肝门肝肿瘤的初步经验  

Preliminary experience of surgical treatment for hepatic hilar tumor invaded the second and the third hepatic portal

作　　者：张雅敏[1] 崔子林[1] 李阳[1] 王连江[1] 侯建存[1] 史瑞[1] 刘子荣[1] 

机构地区：[1]天津市第一中心医院肝胆外科,天津300192

出　　处：《中国普外基础与临床杂志》2017年第9期1062-1065,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结手术切除侵犯第二、三肝门肝肿瘤的实施方法及安全性。方法回顾性分析2012年5月至2017年5月期间于笔者所在医院接受肝切除手术的39例侵犯第二、三肝门肝肿瘤患者的临床资料。结果 39例患者中,原发性肝癌29例,肝血管瘤6例,肝局灶性增生2例,结肠癌肝转移2例。行右半肝切除11例,左半肝切除7例,左外叶切除6例,右三叶切除5例,Ⅴ、Ⅷ段切除4例,Ⅶ、Ⅷ段切除4例,局部切除2例。切肝时完全不阻断入肝血流16例,间断阻断肝门部血流21例,全肝血流阻断2例。手术时间150~270 min,平均190 min;术中失血100~2 000 m L,平均680 m L。术后出现胆汁漏2例,出血1例,无围手术期肝功能衰竭死亡病例。31例肝恶性肿瘤患者术后获访26例,随访时间3~40个月,中位数为8个月。随访期间,12例患者死亡,其中9例死于肿瘤复发,3例死于肝功能衰竭。8例良性肝病患者获访5例,随访时间7~18个月,中位数为9个月,随访期间均健康生存。结论侵犯第二、三肝门肝肿瘤手术切除的关键在于术前对有功能残肝体积的准确评估及术中对肝静脉主要属支的正确处理。Objective To evaluate the safety and ef^cacy ofsurgical resection for the second and the third hepatic portal tumor. Methods The clinical data of 39 patients who underwent surgical resection of the second and the third hepatic portal tumor were analyzed from May 2012 to May 2017 in our hospital. Among them, there were 29 patients with primary liver cancer, 6 patients with hepatic hemangioma, 2 patients with focal liver hyperplasia, and 2 patients with liver metastasis from colon cancer. Results Right liver resection was performed in 11 patients, left liver resection in 7 patients, left outer lobe resection in 6 patients, right trefoil excision in 5 patients, Ⅴ and Ⅷ segment resection in 4 patients, Ⅶ and Ⅷ segment resection in 4 patients, local resection in 2 patients. In the resection, there were 16 patients without interruption of hepatic inflow, 21 patients with interrupted portal blood flow, 2 patients with total hepatic blood flow occlusion. The operative time of the 39 patients was 150-270 min （mean of 190 min）, the intraoperative blood loss was 100-2 000 mL （mean of 680 mL）. Postoperative bile leakage occurred in 2 patients, bleeding occurred in 1 patient, and no liver failure occurred. Twenty-six patients were followed-up of 31 liver cancer patients, and the follow-up time was 3-40 months, the median time was 8 months. During follow-up period, 12 patients died, 9 patients died of tumor recurrence, 3 patients died from liver failure. Of 8 patients, 5 patients with benign liver disease were followed-up for 7-18 months with living healthy, and the median time was 9 months. Conclusion The risk of surgical resection of tumors invaded the second and the third hepatic portal is mainly the accurate functional assessment of residual liver and the correct treatment of the main branches of the hepatic veins.

关 键 词：肝肿瘤 第二肝门 第三肝门 肝切除 初步经验 

分 类 号：R735.7[医药卫生—肿瘤]