168例原发性肝癌切除术后肝创面的处理

Management of Cutting Face of Hepatectomy for Primary Hepatic Cancer

目的 探讨肝癌切除术后肝创面的处理方法。方法 回顾性分析我院2000年6月～2003年10月行肝癌切除术的168例，其中肝脏局部切除50例，左半肝切除24例，右半肝切除36例，右三叶切除24例，肝中叶切除16例，尾状叶切除18例，均仔细处理肝创面，常规放置腹腔引流管。结果 14例术后肝创面并发胆漏，12例保守治疗自愈，2例行ERCP置入支撑管后痊愈。2例并发创面广泛渗血而死亡。结论 仔细缝扎肝创面细小胆管、血管，并辅以止血纱布和生物蛋白胶可以有效减少创面渗血和胆漏，胆漏绝大部分可经保守治疗自愈。

Objective To investigate the management of cutting face of hepatectomy for primary hepatic cancer. Methods 168 cases of primary hepatic cancer underwent hepatectomy were retrospectively reviewed, including regional resection in 50 cases, left lobectomy in 24 cases, right lobectomy in 36 cases, right tri-segmentectomy in 24 cases, meso-hepatectomy in 16 cases and caudate lobectomy in 18 cases, cutting face were carefully treated followed by drainage. Result There were occurrence of bile leakage in 14 cases, among which 12 cases were conservatively cured, 2 cases cured by stent placement under ERCP. 2 cases died of diffuse bleeding from cutting face. Conclusions Suture ligation for the minor bile duct and vessel on the cutting face in a meticulous manner, plus hemostatic gauze and biological protein glue can effectively reduce the bleeding and bile leakage from cutting face. Majority of bile leakage can be cured conservatively.