精准肝脏外科技术在复杂肝脏占位性病变切除中的应用

Clinical application of precise liver resection techniques in patients with complicated liver spaceoccupying lesions

目的评价精准肝切除在复杂肝脏占位性病变外科治疗中的价值。方法分析2006年5月至2009年6月问65例复杂肝脏占位性病变的治疗方法和结果。其中51例患者进行了治愈性肝切除，包括16例肝脏三区切除、11例半肝切除、5例肝中叶切除、3例联合肝段切除、5例尾叶切除、11例不规则肝切除。结果51例实施了治愈性肝切除患者的围手术期死亡率为零，术后主要并发症发生率9．8％（5／51）。19例实施了血管修复／重建的病例在随访结束时血管通畅。10例良性病变的病例术后1年存活，卒100％，41例恶性肿瘤肝切除术后1年存活率92．7％。未实施手术治疗的14例恶性肿瘤病例均在1年内死亡。结论对于部分传统经验评估认为不可切除的复杂肝脏占位性病变，精准肝切除作为一种积极的外科治疗具有重要的临床价值。

Objective To evaluate the early results of precise liver resection. Methods Between May 2006 and June 2009,65 patients with complicated liver space-occupying lesions were included in the study. Fifty-one patients underwent curative liver resection. Liver resections performed included 16 trisectionectomies, 11 hemihepatectomy, 5 mesohepatectomies, 3 combined segmentectomies, 5 caudate lobectomies and 11 irregular local resections. Results Patients undergoing resection had no mortality with a major morbidity of 9.8%. Nineteen vascular repairs and reconstructions were patent at last follow-up. The postoperative 1-year survival rate was 100% in 10 patients with benign lesions and 92. 7% in 41 patients with malignant tumors. The 1-year survival rate was zero in patients with malignant tumors, who underwent no liver resection. Conclusions Precise liver resection, as an aggressive surgical approach, offers hope for these patients, who would otherwise have a dismal prognosis.