累及多肝门的巨大肝肿瘤切除术(附22例报告)

Resection of enormous liver tumors involving multiple hepatic portals: a report of 22 cases

目的探讨累及多肝门的巨大肝肿瘤切除的安全性、可行性及手术方法.方法总结1996年4月至2003年4月间我科收治的累及多肝门的巨大肝肿瘤22例,肿瘤平均直径12.9 cm(8～23 cm).肿瘤同时累及第1和第3肝门者9例,同时侵及第2、3肝门者8例,累及1、2、3肝门者5例.肝肿瘤包括:原发性肝细胞癌14例,胆管细胞癌1例,肝血管瘤4例,肝母细胞瘤3例.癌灶有完整包膜12例(55.5%),无完整包膜10例(45.5%).对肝肿瘤所施手术方法、并发症防治等进行分析.结果全部病例均手术切除,无手术死亡,术中平均出血量1 480 ml(450～4 200 ml),12例施行第1肝门阻断,10例采用了肝门区域选择性血管阻断,手术时间平均195 min.术后无严重并发症,均治愈出院.本组22例病人经1～8年随访,术后存活时间最长已达8年,1年生存率为90.9%(20/22).结论对于累及多肝门的巨大肝肿瘤,只要正确把握手术指征,熟练掌握切肝技术,手术切除是安全的、可行的最佳治疗手段.

Objective To study the satety, feasibilityand operative techniquesot resection of enormous liver tumors involving multiple hepatic portals. Methods The clinical data of 22 cases of enormous liver tumors involving multiple hepatic portals with a mean diameter of 12.9 cm （8-23cm）surgically treated in our hospital from April 1996 to April 2003 were retrospectively analyzed. Of the 22 patients, 9 had the involvement of Both the first and third hepatic portals, 8 both the second and the third hepatic portals and 5 the first, second and third hepatic portals. The liver tumors included primary hepatocellular carcinoma in 14 cases, cholangiocarcinoma in 1, and hepatic hemangioma in 4 and hepatohlastoma in 3. Twelve cases （55.5%） had a complete capsule on the surface of carcinoma focus and 10 had no. The operative techniques and prevention of operative complications were discussed. Results All the liver tumors were resected without operative death. The mean intraoperativeblood loss was 1480 ml （450 ml-4200 ml）. The blocking of the first hepatic portal was performed in 12 cases, the selective blocking of regional blood vessels in hepatic portals in 10. The mean duration of operation was 195 rain. There were no serious postoperative complications and all the patients were cured. All the 22 cases were followed up for 1- 8 years. The longest survival time was 8 years and the 1-year survival rate was 90.9% （20/22）. Conclusions If operative indications are well controlled and operative skills well grasped, hepatectomy is safe, feasible and the best therapeutic measure for enormous liver tumors involving multiple hepatic portals.