肝门区域血管阻断肝段切除335例报告

Hepatic segmentectomy by regional vascular occlusion at hepatic hilum:a report of 335 cases

目的总结在肝门H沟中阻断各肝叶、肝段或肝亚段的入肝血管分支，施行各种类型肝切除的经验。方法回顾性分析四川大学华西医院和成都康桥医院1987—2006年行肝门区域血管阻断肝段切除的335例病人资料，其中根据肿瘤的部位和大小分别行大型肝切除（65例）、间隔性多个肝亚段切除（15例）、邻接多个肝亚段切除（209例）和单个肝亚段切除（46例）。结果术后死亡10例（3．0％）。死于肝衰8例，出血2例。肝细胞癌（HCC）存活10-19年8例，肝内胆管癌术后存活0．5—3年。肝门胆管癌存活11年、5年、4年各1例。胆囊癌存活0．5—1年。良性肝痛切肝后皆痊愈。6例肝内胆管结石尚需处理他处残留结石。结论（1）间隔性多个肝段切除是一次手术治愈多支肝内胆管簇集性结石的有效方法。（2）该手术避免了全阻断入肝血流，缩小了术中肝缺血的范围，有效地减少了术中失血，提高了大肝癌的切除率，减轻了术后肝功能损害，是一个合理、有效、成本低廉的切肝手术方法。（3）从术后长期存活者体会乙肝的现代治疗对预防肝癌的转移和复发有重要意义。

Objective Present the experience on a variety of hepatectomy by occluding the branches of hepatic artery （HA） and portal vein （PV） to the liver lobe, segment or subsegments in hilar H fissure for 335 patients from 1978 to 2006. Methods According to the size and location of liver tumor, major hepatectomy （65 cases）, resection of separated hepatic subsegments （ 15 cases, HS）, resection of adjacent HS （209 cases ）, and resection of single HS （46 cases ） were used to treat these patients. Results （ 1 ） Operative mortality rate was 3. 0% （ 10/335,8 for liver failure and 2 for bleeding） （2）Long-term survival：8 HCC patients survived for 10 - 19 years. 11,5,4 years survival for 1 patient respectively in hilar cholangiocarcinoma. 1/2 -3years survival for intrahepatic cholangiocarcinoma. 1/2 - 1 year survival for carcinoma of gallbladder. All patients of benign liver diseases were cured. Conclusion （ 1 ） Separated multiple hepatic subsegmentectomy is an effective procedure in one operation to cure the compacted stones in 2 -6 subsegmental hepatic ducts both in right and left lobes. （2） This procedure is reasonable, effective and low cost for hepatectomy. （ 3 ） Current treatment of B hepatitis is essential for preventing metastasis or recurrence after resection of HCC associated with B hepatitis based on the experience of long-term survivals.