肝中叶切除术临床应用体会

CLINICAL STUDY OF MESOHEPATECTOMY

目的 评价肝中叶切除治疗肝中央叶段肿瘤的手术方法和疗效。方法 回顾分析2006年8月～2008年4月在我科行肝中叶切除的12例患者临床资料；Child A级8例，Child B级4例，肝硬化8例；行肝Ⅳ＋Ⅴ＋Ⅷ段，联合胆囊切除3例，肝Ⅳb＋Ⅴ段，联合胭囊切除6例，肝Ⅳa＋Ⅷ段切除2例，Ⅷ段切除1例；第一肝门阻断7例（时间15～40min），全肝血流阻断2例（时间20～45min）；预防一眭胆总管切开、T管外引流4例。结果术中输血1例，输血量400ml；所有病例手术过程顺利，切除标本大小（最大径）5～15cm，平均7．5cm；无手术死亡，术后并发症：阻塞性黄疸伴胆漏1例，腹腔包裹性积液3例，肺部感染1例，切口感染1例。术后病理：原发性肝癌5例，肝癌切除术后复发1例，胆管细胞癌1例，混合性肝癌1例，胆囊癌1例，结肠癌术后肝转移1例，间叶性错构瘤1例，肝母细胞瘤1例。所有病例均随访，随访时间为1～32个月。其中1例混合性肝癌患者术后5月出现肿瘤肝内复发及后腹膜、腰椎转移，余病例均无瘤生存。结论 虽然肝中叶切除技术比较复杂，但仍是治疗包括肝癌在内的各种肝中叶肿瘤的有效方法，选择性应用肝血流阻断技术是控制术中出血的重要措施。

Objective To evaluate the surgical technique and effects of mesohepatectomy for treatment of centrally located hepatic tumor in 12 cases. Methods Analyse the data of 12 patients underwent mesohepatectomy in our department from August 2006 to April 2008 retrospectively. The preoperative liver function was graded as A in 8 patients and B in 4 patients. Liver cirrhosis was in 8 patients. Pringle＇ s maneuver applied in 7, and total hepatic vascular exclusion in 2, the occlusion time ranged from 15 -40 and 25 - 45 minutes, respectively. Three cases underwent segments Ⅳ, Ⅴ ,ⅧI hepatectomy and 6 segments Ivb and V hepatectomy, all com- bined cholecystectomy. 2 cases underwent segments Iva and Ⅷ hepatectomy, and 1 segment Ⅷ hepatectomy. Prophylactic exploration of the common bile duct was in 4 patients. Results 400 ml intraopertive blood transfusion was performed in 1 ease. The duration of operation in all cases were successfully. The diameters of excisional liver specimen measured 5 - 15cm, and 7.5cm in average. There was no operative death. The postoperative complications were： 1 was with obstructive jaundice and billiary fistula ; 3 with encapsulated coelio - effusionthere ; 1 with pulmonary infection and 1 with infection of incisional. Histologic diagnosis ： primary hepatic carcinoma was in 8, liver metastasis neoplasma in 1, carcinoma of gallbladder in 1, Mesenchymal hamartoma in 1, hepatoblastoma in 1. All patients were follow - up, ranged from 1 - 32 months. Conclusion Mesohepatectomy is a complicated technique, but it may be seen as an effective method to cure many kinds of tumor centrally located in liver, including hepatocarcinoma, and using the technique of blockage of liver blood flow selectively is an important measure to control bleeding in hepatectomy.