右叶中央深部小肝癌的简化手术切除

SUMPLIGED RESECTION OF SMALL HEPATOCELLULAR CARCINOMA LOCATED DEEP IN THE MIDDLE OF THE LIVER

目的探讨对右叶中央深部小肝癌采用癌剜出术治疗的临床意义。方法我院1991年3月-1996年12月期间，采用肝癌剜出术加无水酒精残端处理方法手术切除15例直径小于4cm的小肝癌。结果本术式操作简便，比常规的不规则肝切除手术费时短、出血少、对肝功能的影响不大，无明显的术后并发症，与不规则切除术比较生存率无显著性差异。结论肝癌剜出术适合于伴中重度肝硬化、肿瘤深在于肝实质内、包膜完整、直径小于4cm的单个中央型小肝癌，也适合于术后复发的小肝癌，但手术过程中须有术中B超的指导和无水酒精的残端处理。此方法简单、实用、安全可行，经术后临床随访，疗效令人满意。

Objective To explore effect of simplified resection to treat samll hepatocelular carcinoma (sHCC) located deeply in the middle of right lobe of the hver.Method From March,1991 to December,1996, fifteen patients with sHCC located deeply in the middle of right lobe of the liver were treated with surgical resec- tion,in which the tumor was removed by dig-out method and then the surgical margin was treated with ethanol.Re- sults This type of operation was simpler to perform with shorter operation time,less bleeding,and more liver parenchymal cells were reserved as compared to the irregular resection.No complications were found.The survival rate was not significantly different from that of the irregular resection.The follow-up result was satisfactory.Con- clusions The operation using dig-out method to remove the tumor is suitable for single sHCC(≤4cm) which lo- cates deeply in the middle of right lobe of the liver,has complete capsule and is accompanied by moderate or se- vere cirrhosis.It is also suitable for resection of recurrent sHCC after hepatectomy.It is important that the opera- tion must be guided by intraoperative ultrasonography and the surgical margin should be managed with ethanol.The method is simple,practical and safe.