第Ⅷ肝段切除治疗肝细胞癌

Resection of segment Ⅷ of liver for treatment of hepatocellular carcinoma

目的评价第们段肝癌切除的手术技术。方法回顾总结９例第Ⅷ段肝癌手术切除的经验，９例患者均伴有肝炎后肝硬化，术前肝功能，ＣｈｉｌｄＡ级７例，ＣｈｉｌｄＢ级２例。肿瘤最大径４—６ｃｍ，４例术中施行全肝血流阻断（ＴＨＶＥ），阻断时间为６－１４分钟，４例在施行ＴＨＶＥ后成功地修复了损伤的主肝静脉和下腔静脉。结果９例第Ⅷ段肝癌得以顺利切除，术中输血６００～１２００ｍｌ，无手术死亡。术后并发症：右侧胸腔积液２例，胆漏１例。结论第Ⅷ肝段切除是一种十分困难而危险的局限性肝切除，因为很多壁薄如纸的肝静脉在第Ⅷ肝段顶部汇入主肝静脉并进入下腔静脉。虽然第Ⅷ肝段切除技术是困难的，但仍是治疗原发性肝癌的一种选择。而常温下全肝血流阻断是控制术中大出血的重要措施。

Obhective To evaluate the operative technique of resection of segment Ⅷ of the liver for hepatocellular carcinoma. Methods Nine patients with hepatic carcinoma in segment Ⅷ were studied. All patietnshad post hepatitis cirrhosis. Their liver function was: Child A in 7 patients and Child B in 2 patietns. The tumor diameters were between 4cm and 6cm. Resection of segment Ⅷ was performed under total hepatic vascular exclusion (THVE) in 4 patients. The total exclusion time ranged ranged 6 to 14 minutes. Four patients required repair ofmajor hepatic veins and/or inferior vena cava after control of bleeding with THVE. Results Resection of Ⅷ of the liver wes successfully performed in all patients. The amount of blood transfused during operation rangedfrom 600 to 1200 ml. There was no operative death. The complications after operation were: right pleural effusionin 2 cases and binary fitula in 1. Conclusions Resection of segmentt Ⅷ is the most difficult and dangerous operation of limited hepatic resection, largely because of the then-walled, multibranched nature of the very large majorhepatic veins that come together to the inferior vena cava at the apex of segment Ⅷ. Though the operation technique is difficult to master, it is still the treatment of choice for patients for primary liver cancer. THVE is an im-portant technique for controlling severe bleeding during the operation.