逆行肝脏部分切除术

Retrograde partial hepatectomy:report of 11 patients

目的为常规方法切除困难的肝脏肿瘤寻找一种新的切除径路。方法手术程序与常规肝切除术相反，即首先离断肝脏，然后分离肿瘤与膈肌间的粘连或切除受累膈肌，切断相应韧带，去除肿瘤。如周围脏器被肿瘤侵犯或有紧密粘连难以分离，则将受累部分器官连同肿瘤一起切除。结果１９９４年６月至１９９６年１月已用该法切除肝脏恶性肿瘤１１例，平均手术时间为１９２ｍｉｎ（１５０～２５０ｍｉｎ），术中平均失血量１４６０ｍｌ（８００～４２００ｍｌ），全组无手术死亡，术后均顺利恢复。

Objective To study a new approach to hepatectomy for liver tumors resected difficultly by typical method. Method The operative order is retrograde as compared with typical hepatectomy, namely, transection of the liver is performed first, isolating adhesions between the tumor and the diaphragm or partial invaded phrenectomy is performed second, and then after cutting corresponding ligaments, liver tumor is removed. If the surrounding organs were invaded or adhered by tumor too tightly to be separated. They were resected with the tumor. Result The approach was used in 11 patients with malignant tumors of liver from June 1994 to January 1996. Operation time was 192 min (150～250 min) and estimated blood loss during operation was 1460 ml (800～4200 ml). No operative mortality was found and all of the patients recovered uneventfully. Conclusion The retrograde partial hepatectomy is a good method for resection of liver tumors resected difficultly by typical hepatectomy.