肝三叶切除术11例报告

Hepatic trisegmentectomy for treatment of liver tumors

目的评价肝三叶切除治疗肝巨大肿瘤的手术技术和经验。方法本组肝三叶切除术１１例术前肝功能均为ＣｈｉｌｄＡ级，无肝硬化。瘤体最大横径为１２～３５ｃｍ，行右三叶切除７例，左三叶切除４例。术中施行全肝血流阻断６例，阻断时间为６～２２分钟，其中在全肝血流阻断下成功修复损伤的下腔静脉和主肝静脉各２例。结果术中输血４００～１６００ｍｌ，无手术死亡。术后并发症：胆瘘和右侧胸腔积液各２例。切除肿瘤湿重量：１２００～６５００克。术后诊断：肝细胞癌５例，肝母细胞瘤２例，肝血管瘤２例，肝细胞腺瘤和粘液瘤各１例。结论虽然肝三叶切除技术是困难的，但仍是治疗肝脏巨大肿瘤的一种选择。

Objective To evaluate the surgical technique and experience of hepatic trisegmentectomy for treatment of huge liver tumors in 11 cases.Methods trisegmentectomy performed on 11 noncirrhotic patients for their liver tumors were retrospectively reviewed.The preoperative liver function was all graded as Child A.The tumor diameters measured 12 cm to 35 cm.Seven patients underwent right trisegmentectomy,and 4 left trisegmentectomy.Total hepatic vascular exclusion was used during the operation in 6 patients.The occlusion time ranged from 6～22 minutes.Successful repair was performed under blood blockade for the inadevertent injury of the hepatic veins and IVC caused by hepatectomy in two cases each.Results Intraoperative blood transfusion ranged from 400 ml to 1 600 ml.The tumor weight ranged from 1 200 g to 6 500 g.There was no operative death.The postoperative complications were:right pleural effusion in 2 and biliary fistula in 2. Histologic diagnosis:hepatocellular carcinoma was in 5,hepatoblastoma in 2,hepatic hemangioma in 2,hepatic adenoma in 1 and hepatic myxoma in 1.Conclusions Hepatic trisegmentectomy though technically difficult to perform is still indicated in good risk patients with huge liver tumors,and total hepatic vascular exclusion is necessary to control severe bleeding during the operation.