持久美蓝染色法在精准肝切除中的应用价值

Application of lasting methylene blue staining in precise hepatectomy

目的探讨持久美蓝染色法在精准肝切除中的应用价值。方法回顾性分析2009年2月至8月解放军总医院对21例肝癌患者采用美蓝染色后行精准肝切除的临床资料。首先在肝门部解剖出拟切除肝段的肝蒂，然而在Glisson鞘内门静脉远端注射美蓝后结扎该段肝蒂，使拟切除肝段染色，按染色的界限行肝段切除。结果Glisson鞘内注射美蓝染色的成功率为100％，美蓝在拟切除肝段的肝实质内停留（80±23）min。21例患者均行精准肝切除，其中右半肝2例，左半肝1例；右后叶2例，右前叶3例，左外侧叶1例；肝Ⅷ段2例，肝Ⅶ段3例，肝Ⅵ段1例，肝Ⅳ段2例；联合肝段切除4例。平均术中出血量为（236±6）ml，术后并发症发生率为14％（3／21），平均术后住院时间为（12±3）d。结论注射美蓝后结扎肝蒂的染色方法成功率高，染色时问持久，对肝实质离断过程中的切面选择具有引导作用，有助于提高解剖性肝切除的精准性。

Objective To investigate the clinical value of lasting methylene blue staining in precise hepateetomy. Methods The clinical data of 21 patients with liver cancer who received precise hepatectomy after methylene blue staining at General Hospital of PLA from February to August in 2009 were retrospectively analyzed. After the hepatic pedicle was dissected, methylene blue was injected into the portal vein, and then the hepatic pedicle was ligated. Parenchymal division is initiated along the line of devascularization demarcated on Glisson capsule. Results The success rate of methylene blue staining was 100%. Methylene blue retained in the parenchyma for （80 ±23 ） minutes. Right hepatectomy was performed on 2 patients, left hepatectomy on 1 , right posterior lobectomy on 2, fight anterior lobectomy on 3, left lateral lobectomy on 1, segmentectomy of segment Ⅷ on 2, segmentectomy of segment Ⅶ on 3, segmentectomy of segment Ⅵ on 1, segmentectomy of segmentⅣV on 2 and combined segmentectomy on 4. The mean volume of blood loss, incidence of postoperative complications and postoperative hospital stay were （236 ± 6） ml, 14% （3/21） and （ 12 ± 3 ） days. Conclusions Ligation of hepatic pedicle after methylene blue injection has the advantages of high success rate and lasting staining of parenchyma of liver. Especially, this staining method contributes to improve the precision of hepatectomy by guiding the segment selection during parenchyma transection.