小儿巨大肝肿瘤切除术探讨

Resection of Huge Liver Tumor in Children

目的对小儿巨大肝肿瘤切除术安全性和可行性进行探讨。方法从2001年7月至2007年10月,本研究采用不阻断肝门规则性肝切除方法,对39例巨大肝肿瘤患儿实施肿瘤切除术。本组患儿年龄为28d至14岁,平均为3.6岁。其中,男性患儿为24例,女性为15例;肿瘤直径为9cm^25cm,平均为14.7cm。本组肝母细胞瘤为30例(1例右半肝和左外叶内分别有一肿块;1例右半肝、左外叶内和左内叶分别有一肿块;14例患者肿瘤位于右半肝,4例位于左半肝,7例位于右三叶,2例位于左三叶,1例位于右后叶),良性巨大肝肿瘤患儿为9例(肝错构瘤4例,肝血管瘤4例,淋巴管瘤1例)。结果本组39例患儿全部手术成功,无术中死亡,无不能完整切除者;手术时间为90min^390min,平均为205min。本组患儿行右半肝(~)切除18例,右三叶切除7例,左三叶切除2例,左半肝切除7例,右半肝+左外叶切除1例,第二肝门及右下叶肝段切除各2例;术中出血量为50ml^600ml,26例行输血治疗。本组患儿于术后第1~第3天进水,平均住院时间为15.2d;术后无肝衰竭、胆漏、消化道出血和肠梗阻症状。对右半肝、左外叶内和左内叶均有一肿块的患儿(1例),行左三叶切除,仅保留右肝,段,术后出现肝功能不足、黄疸,2周后恢复正常,肝大。本组无围手术期死亡病例,目前随访已有2例死亡(肝母细胞瘤患儿)。本组9例良性巨大肝肿瘤患儿术后随访7个月至6年,目前均健康,无肿瘤复发;30例肝母细胞瘤患儿术后常规化疗,已随访6~65个月,无瘤生存27例,其中,存活2年以上18例,肝功能正常。结论巨大肝肿瘤切除术是一种安全可行的手术。术者熟练的肝脏解剖知识和肝切除技术,术前可靠的影像学技术支持,术中正确处理肿瘤相关血管,是保证手术成功的关键。

Objective To investigate the feasibility and safety of resection of huge liver tumor in children. Methods From June 2001 to October 2007, 39 children ranged from 28 days to 14 years old with huge liver tumor underwent hepatectomy treatment in the First Affiliated Hospital of Peking University. The diameter of tumors varied from 9 cm to 25 cm. In these patients, 30 cases were hepatoblastoma, and 9 cases were benign huge liver tumor. Results Resection of the huge liver tumor was successfully accomplished in 39 patients. Right hemihepatectomy （segment Ⅴ to Ⅶ） was undertaken in 18 cases, right trihepatectomy （segment Ⅰ ,Ⅳ ,Ⅴ to Ⅷ） in 7 cases, and left trihepatectomy （segments Ⅰ to Ⅴ and Ⅷ） in 2 cases, left hemihepatectomy in 7 cases, segment Ⅳ , Ⅶ and Ⅷ and segment Ⅴ and Ⅵ resections in each one respectively; 2 cases died. During the follow-up period, 27 patients survived without any tumor recurrence. One patient with 2 tumors in right and left lobes died of brain and lung metastasis at the seventh month after operation, and 1 case died of tumor metastasis after two and a half years. Conclusion Resection of huge liver tumor is an effective, safe and feasible operation for children with huge liver tumor.