鼓肺排气一期缝合膈肌缺损法在肝癌合并膈肌侵犯手术中的应用

Clinic application of lung dilation combined with primary suturing of defective diaphragma for the patients with hepatocellular carcinoma which invaded diapghragma

目的介绍鼓肺排气一期缝合膈肌缺损法在肝癌合并膈肌侵犯手术中的应用,评估其安全性和可行性。方法对中国人民解放军总医院肝胆外科2005年4月至2008年9月收治的8例肝癌合并膈肌侵犯病人,行手术切除肝癌及受侵膈肌,膈肌缺损处采用鼓肺排气一期缝合,不放置胸腔闭式引流。结果手术经过顺利,术后病理提示手术切缘阴性,无围手术期死亡及严重肺部并发症发生,7例术后有少量胸腔积液,1例中等量胸腔积液合并肺膨胀不全,穿刺引流后治愈,平均术后住院9.3d。平均随访13.4(6～28)个月,1例因肿瘤复发于术后1年死亡,3例复发,余4例至今仍未复发。结论鼓肺排气一期缝合膈肌缺损在肝癌合并膈肌侵犯手术中应用是安全、可行的,操作简便,可有效地避免胸腔闭式引流对病人的负面影响。

Objective To introduce the clinic applieation of lung dilation with primary suturing of defeetive diaphragma for the patients with hepatocellular carcinoma which invaded diapghragma. Methods l）uring Apr 2005 to Sep 2008, 8 palients with hepatoeellular carcinoma whieh invaded diapghragma were treated by the above procedure combined with resection of hepatoeellular carcinoma and partial diaphragma, closed drainage of thoracic cavity had not been utilized in all cases. Date eorrelated with patients was collected prospectively. Results All operations were completed smoothly, postoperative pathology, indieated.the operative margin was clean in all cases. There was no peroperative death and no severe complication of h, ng. 7 Cases suffered a small quantity of pleural effusion post-operation, 1 ease with medium dose of pleural effusion combined with atelectasis was eured by simple transeutanenus draining under uhrasonography. Mean time of postoperative hospitalization was 9.3 days. Follow-up, mean time 13.4 （6 - 28）months showed that 1 ease died of tumor reeun＇enee 1 year after operation, reurrenee was forund in 3 cases. Conclusion Lung dilation with primary suturing of deflective diaphragma is feasible and sale for the patients with hepatoeellular eareinoma which invaded diapghragma, and it is simple on the technique, which could efficiently avoid the negalive influence of closed drainage of thoraeic cavity to the patient.