保留肝右动脉的缩小右半肝切除术治疗肝硬化肝癌  

Reduced right hepatectomy with reserved right hepatic artery for hepatocellular carcinoma complicated with liver cirrhosis

作　　者：陈骋[1] 郑进方[1] 陈劲松[1] 刘俊[1] Chen Cheng;Zheng Jinfang;Chen Jinsong;Liu Jun(Department of Hepatobiliary and Pancreatic Surgery,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院肝胆胰外科,海口570311

出　　处：《中华肝脏外科手术学电子杂志》2021年第6期570-573,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：海南省高等学校科学研究项目(Hnky2019-53)。

摘　　要：目的探讨保留肝右动脉的缩小右半肝切除术治疗肝硬化肝细胞癌(肝癌)患者的安全性和疗效。方法回顾性分析2018年7月至2019年4月海南省人民医院行保留肝右动脉的缩小右半肝切除术的8例肝硬化肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男7例,女1例;平均年龄(51±8)岁。术前采用三维重建软件测算全肝体积、残肝体积。分离、结扎门静脉右支,保留肝右动脉,沿左右肝缺血分界线右移1 cm切除右半肝,保留部分肝组织。观察患者围手术期情况。结果术前采用三维重建软件模拟右半肝切除,标准肝体积为(993±64)ml,标准右半肝切除的残肝体积为(348±32)ml,占标准肝体积的(35.0±2.3)%;切除平面右移1 cm后残肝体积为(428±34)ml,占标准肝体积的(42.7±1.4)%。所有患者均顺利完成保留肝右动脉的缩小右半肝切除术,术中未发生与操作有关的并发症,保留的肝组织颜色红润。手术时间(224±43)min,术中出血量(220±52)ml。术后肝功能指标呈一过性升高,随后出现下降,术后7 d基本恢复正常。术后腹腔引流液较少,均于术后6 d内拔除腹腔引流管。无发生小肝综合征及肝衰竭。结论保留肝右动脉的缩小右半肝切除术是一种安全有效术式,对于肝硬化肝癌的患者可能是一种新的术式选择,其有利于保留更多肝组织,预防术后肝衰竭。Objective To evaluate the safety and efficacy of reduced right hepatectomy with reserved right hepatic artery in the treatment of hepatocellular carcinoma(HCC)complicated with liver cirrhosis.Methods Clinical data of 8 HCC patients complicated with liver cirrhosis who underwent reduced right hepatectomy with reserved right hepatic artery in Hainan General Hospital from July 2018 to April 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,7 patients were male and 1 female,aged(51±8)years on average.The volumes of total liver and residual liver before surgery were measured by 3D reconstruction software.The right branch of the portal vein was separated and ligated.The right hepatic artery was reserved.The right liver was resected 1 cm rightwards from the ischemic line of left and right lobe,and liver tissues were partially preserved.The perioperative conditions of patients were observed.Results Preoperatively,3D reconstruction software was employed to simulate the right hepatectomy.The standard liver volume was(993±64)ml.The residual liver volume after standard right hepatectomy was(348±32)ml,accounting for(35.0±2.3)% of the standard liver volume.The residual liver volume was(428±34)ml after the resection plane was shifted 1 cm to the right side,accounting for(42.7±1.4)% of the standard liver volume.The right hepatectomy with reserved right hepatic artery were successfully completed in all the patients.No intraoperative complications occurred.The preserved liver tissues were found with normal redness.The operation time was(224±43)min and intraoperative blood loss was(220±52)ml.After operation,the parameters related to liver function were increased transiently,and decreased subsequently,and basically restored to normal at postoperative 7 d.After operation,the amount of abdominal drainage was slight,and all the abdominal drainage catheters were removed within postoperative 6 d.No small-for-size syndrome or live

关 键 词：癌 肝细胞 肝硬化 肝切除术 肝功能衰竭 

分 类 号：R735.7[医药卫生—肿瘤]