肝三叶切除33例临床分析

The clinical study of trisegmentectomy for 33 cases with liver disease

目的探讨肝三叶切除术在临床应用的可行性和安全性。方法2005年1月-2009年1月我们对33例肝脏病变采用肝三叶切除术,其中巨大肝癌28例、巨大肝血管瘤2例、肝包虫病2例、肝囊腺瘤1例。术前肝功能均为Child A级。结果行右三叶切除26例,左三叶切除7例,其中联合胃次全切除3例,横结肠及脾切除各1例。对肝癌合并门静脉/下腔静脉癌栓者,术中同时行取栓术。累计阻断时间14~47min,平均19min。术中出血400-3200ml不等,平均850ml。本组患者围手术期无1例死亡。肝癌患者中术后生存超过12个月19例（67.8%）,24个月12例（42.8%）,30个月9例（32.1%）,其余良性病变者均健康生存。结论掌握手术指征和手术技巧,并作好围手术期处理,肝三叶切除术仍是安全、有效的。

Objective To explore the safty and feasibility of trisegmentectomy in clinic.Methods Trisegmentectomy was performed on 33 cases of liver disease from january 2005 to january 2009,which including 28 cases of giant liver cancer,2 giant hepatic haemangioma,2 hepatic echinococcosis and 1 hepatic cystoadenoma.The preoperative liver function of all was graded as Child A.Results 26 cases underwent right trisegmentectomy and 7 cases left trisegmentectomy,3 cases accepted sub-gastroctomy,1 case spleenectomy and 1 case colonectomy concurrently.Extraction was performed on cases with tumor thrombi intraoperatively.Mean hepatic pedicle occulsion duration was 19 minutes（range 14~47）,and mean blood loss was 850ml（range 400-3200）.No death occured in perioperative duration.Of patients with liver cancer,19 cases have survived over 12 monthes,12 cases over 24 monthes and 9 cases over 30 monthes.Others with benign disease have survived healthly till now.Conclusion with strict indication,operative skill and proper perioperative treatment,trisegmentectomy is still safe and feasible.