肝巨大占位的外科手术治疗策略  

Surgical treatment strategy of huge hepatic space occupying

作　　者：李国松[1] 魏东[2] 郭志唐 李文[2] 施智甜 马瑞成 叶正成 翟广 钟超 李珂佳[2] 王琳[2] 戈佳云[2] Li Guosong;Wei Dong;Guo Zhitang;Li Wen;Shi Zhitian;Ma Ruicheng;Ye Zhengcheng;Zhai Guang;Zhong Chao;Li Kejia;Wang Lin;Ge Jiayun(Department of Hepatobiliary Surgery,the Second People′s Hospital of Baoshan City,Yunnan Baoshan 678000,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650101,China)

机构地区：[1]云南省保山市第二人民医院肝胆外科,云南保山678000 [2]昆明医科大学第二附属医院肝胆胰外科,云南昆明650101

出　　处：《腹部外科》2020年第2期127-131,共5页Journal of Abdominal Surgery

基　　金：云南省科技计划项目-应用基础研究(昆医联合专项)[2017FE467(-183),2017FE468(-057)]。

摘　　要：目的探讨精准肝切除在肝巨大占位手术治疗中的应用价值。方法回顾性分析昆明医科大学第二附属医院2018年1月至2020年1月收治的28例肝巨大占位(直径>10.0 cm)手术治疗病人的病例资料,行相关临床观察并对病人进行随访。结果手术时间(198.21±51.86)min,术中第一肝门阻断时间(33.75±11.27)min,术中出血(667.89±10.15)ml。术后胆瘘6例,其中2例行经内镜逆行胰胆管造影术(ERCP)+内镜下鼻胆管引流术(ENBD)痊愈,另4例保守治疗痊愈。1例病人因术后手术创面渗血再次手术止血。住院时间(12.96±3.78)d。随访时间(12.64±5.57)个月(2~24个月),其中1例术后7个月因肺栓塞死亡;4例出现复发和局部转移,目前带瘤生存,23例门诊复查无异常。结论对于肝巨大占位且肝功能Child-Pugh分级在A级的病人,手术切除是最好的治疗手段,其中精密的术前评估是基础,精致的手术规划是关键,精细的技术操作是核心,精良的术后处理是保障。Objective To explore the application value of precise hepatectomy in the surgical treatment of giant liver mass.Methods Retrospective analysis was made on the case data of 28 patients with large liver occupation(diameter>10 cm)who were admitted to the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2020 for surgical treatment.Relevant clinical observations were made and patients were followed up.Results All patients successfully completed the operation and were cured and discharged.The operation time was(198.21±51.86)min,the first hepatic hilum blocking time was(33.75±11.27)min,intraoperative hemorrhage was(667.89±10.15)ml,6 patients had bile leakage after operation(2 patients were cured by ERCP+ENBD,4 patients were cured by conservative treatment),1 patient had reoperation for hemostasis due to postoperative wound bleeding,and the hospital stay was(12.96±3.78)days.At the follow-up(2-24)months,1 patient died of pulmonary embolism 7 months after operation,4 patients had recurrence and local metastasis,and the tumor-bearing survival was achieved at present,while 23 patients had no abnormalities in outpatient follow-up.Conclusion For patients with huge mass in liver and liver function Child-Pugh grade A,surgical resection is the optimal treatment method,in which precise preoperative evaluation is the basis,delicate surgical planning is the key,precise technical operation is the core and excellent postoperative management is guaranteed.

关 键 词：肝巨大占位 外科手术 解剖性肝切除 靶向治疗 

分 类 号：R735.7[医药卫生—肿瘤]