肝脏三叶切除术治疗肝脏肿瘤60例报告

Hepatic trisectionectomy for liver neoplasm:a report of 60 cases

目的探讨肝脏三叶切除术的手术技术。方法回顾性分析第二军医大学东方肝胆外科医院2000年1月至2005年12月行肝脏三叶切除60例病人的临床资料。结果全组术前肝功能Child—Pugh分级均属A级．57例（95％）评为5分，3例（5％）评为6分。肿瘤直径平均15．2（5～27）cm，其中〈15cm14例．15．20cm34例，〉20cm12例。行左三叶切除24例，右三叶切除36例。联合尾状叶切除1例、门静脉取栓3例、下腔静脉取栓＋右肾上腺切除l例、胆管切开取栓2例、淋巴结清扫4例。60例均行常温下第一肝门阻断法切肝，阻断1次者30例，2次者15例，3次者15例。阻断总时间最长73min，平均30．1min；单次阻断最长45min。术中出血最少200mL，最多11000mL，平均1605mL。输血最多13200mL，平均2003mL。未输血者15例。术后并发症发生率为13.3％（8／60），手术死亡率为3.3％（2／60）。结论肝三叶切除是治疗肝脏肿瘤的有效方法，术前对肝脏储备功能的准确评估是术后肝功能恢复的保证。术野良好的暴露，肝创面的妥善处理及对残肝内重要结构的保护，是减少术后并发症的重要保证。

Objective To investigate the surgical technique of hepatic trisectionectomy. Methods The clinical data of 60 patients performed hepatic trisectionectomy between January 2000 and December 2005 at the Eastern Hepatobiliary Hospital of Second Military Medical University were analysed retrospectively. Results Liver function classification were Child-Pugh A in all patients. Among them, 57 patients （95%）were score 5 and 3 patients （5%）score 6. Average diameter of tumor was 15.2cm （range 5--27cm）. Among them, diameters of 34 patients （56.7%） were not less than 15cm, and those of 12 patients （20%） were not less than 20cm. Left trisectionectomy was performed in 24 patients, and right trisectionectomy was performed in 36 patients. Added caudatectomy was performed in 1 patient, and portal vein thrombosis extraction was performed in 3 patients. Vena cava thrombosis extraction plus right adrenal grand resection was performed in 1 patient. Exploration and extraction for thrombus in common bile duct was perfomed in 2 patients, and lymphadenectomy was performed in 4 patients. Hepatic resection was performed clamping of the hepatic pedicle at room temperature in all patients. The longest of total clamping period and single clamping were 73 minutes and 45 minutes, and the average were 30.1 minutes. The maximum of blood transfusion and average blood transfusion were 13 200 mL and 2003 mL, and no transfusion needed in 15 patients. Postoperative complications occurred in 8 patients （13.3%）, and 2 of the 60 patients （3.3%）died. Conclusion Hepatic trisectionectomy is an effect surgical therapy for liver neoplasm. To reduce postoperative complications, proper evaluation of liver reserve capacity before operation, good exposure in operation, well management of hepatic wound, and kind protection of vital structure are essential.