术中超声在切除邻近肝静脉主干中央型深部小肝癌的应用

Application of intraoperative ultrasound and appropriate approach in local resection for the deeply-situated central small hepatocellular carcinoma

目的：探讨术中超声加合适径路在切除邻近肝静脉主干中央型深部小肝癌中的作用。方法：在术中超声指导下，采用沿肝解剖平面剖开或肝表面揭盖径踢对８例位于肝实质深部、邻近肝静脉主干伴有中度以上肝硬变的中央型小肝癌施行局部切除术。结果：全部病灶均田术中超声获得准确定位并得以成切切除，除１例在切肝过程中损伤肝申静脉外，其余７例无肝静脉的损伤。无手术死亡，术后肝功能恢复良好。结论：术中超声指导下经合适径路行局部切除的方法，适用于伴有中度以上肝硬变的中央型深部小肝癌，术申超声对防止肝静脉的损伤起重要作用。【

Objective: To investigate the role of intraoperative ultrasound(IOUS) and appropriate approach in local resection for the central small hepatocellular carcinoma(sHCC) which is deeply situated within the parenchyma and adjacent to the hepatic veins. Methods: under IOUS guidance, local resection was carried out for 8 cirrhotic patients with central sHCC which was deeply located and adjacent to hepatic veins by approach of splitting or unroofing superficial hepatic parenchyma. Results: All tumors were precisely localized by IOUS and excised successfully. Except for injury to central hepatic vein in 1 case, no other injury occurred to the hepatic veins in the remaining 7 cases. There was no postoperative mortality, and the liver function recovered well in all cases postoperatively. Conclusion: Local resection by using IOUS and appropriate approach is applicable for the cirrhotic patients with deeply located central sHCC. IOUS plays an important role in avoidance of injuries to the hepatic veins.