解剖第三肝门切除巨大肝癌（附12例报告）

Resection of giant hepatocellular carcinoma after dissection of third porta hepatis （report of 12 cases）

目的 探讨解剖第三肝门在巨大肝癌切除中的意义.方法 回顾性分析我院自2006年2月至2008年3月对12例肝右叶巨大肝癌患者解剖显露第三肝门的方法行半肝或右三叶切除术切除巨大肝癌的临床资料.结果 本组12例经解剖显露第三肝门后顺利切除肿瘤.平均结扎肝短静脉4.1支,第一肝门平均阻断时间38.5 min,术中平均出血量735 ml.未发生大出血及空气栓塞,亦无术后肿瘤残留及肝、肾功能衰竭等严重并发症.全组病例均未行全肝血流阻断.结论 行第三肝门解剖切除右肝巨大肝癌,能完整切除肿瘤,提高肿瘤切除率;减少术中出血量及肝门阻断时间,减少损伤肝短静脉或下腔静脉而引起的大出血及空气栓塞;减少术后肿瘤残留率.

Objective To investigate the significance of dissection of the third porta hepatis in hepatectomy of giant hepatoearcinoma. Methods Dissection of the third porta hepatis following a complete removal of tumor was applied to 12 patients with giant hepatocellular carcinoma of right liver in our hospital from February 2006 to March 2008. Results The 12 patients underwent resection of giant liver tumor. The number of short hepatic veins ligated was 4.1 on average; an intermittent Pringle^s ma- noeuver was used with an average occlusion time of 38.5 rain ; the average blood loss was 735 ml. No se- vere hemorrhage or air embolism occurred during operation, and severe complications such as residue of tumor, hepatic failure or renal failure did not occur after the operation. Obstruction of entire blood supply of the liver was not performed in all cases. Conclusion Dissection of the third porta hepatis following a complete removal of giant hepatocellular carcinoma of right liver is safe and feasible. This technique can reduce amount of blood loss,shorten obstruction time of the porta hepatis,and decrease the risk of severe bleeding and air embolism because of damage of the short hepatic veins or inferior vena cava, and can raise rate of resection of giant hepatocellular carcinoma.