前入路肝切除术治疗右肝巨大肿瘤

Right hepatic resection using anterior approach for large right hepatic tumor

目的 评估前入路肝切除技术治疗右肝巨大肿瘤的安全性.方法 在处理右侧肝门之后,与传统肝切除技术不同的是,先沿缺血线离断肝实质,处理肝短静脉和肝右静脉;然后游离肝右叶并处理肝脏与周围结构的粘连或侵犯.结果 自2000年1月至2006年12月共对24例直径大于10 cm右肝巨大肿瘤采用前入路途径行右半肝或扩大右半肝切除术,肿瘤平均直径约15.7 cm,最大26 cm.所有病人均安全完成手术.平均术中估计失血量和术中输血量分别为734 ml和620 ml,平均手术时间296 min,无术后严重并发症和住院病死病例.结论 针对传统手术模式难以切除的右肝巨大肿瘤,前入路技术是一种安全的、应该优先选择的手术方式.

Objective To analyze the advantages of right hepatic resection using the anterior approach for large right hepatic tumors. Methods After initial control of the right liver hilum, liver parenchyma was transected along the ischemic plane down to the anterior surface of the inferior vena cava. All the small caval branches were individually ligated and divided. The right hepatic vein was then isolated, divided and sutured. Sequentially, the right hepatic lobe and tumor were mobilized from the right abdominal cavity in the usual manner and delivered. Results The anterior approach was used for right hepatic resection in 24 patients with huge right hepatic tumors from January 2000 to December 2006 in our hospital. The median size of the tumors was 15.7 cm. Intraoperative blood loss and blood transfusion volume were 734 ml and 620 ml, respectively. No major postoperative complications or hospital death occurred. Conclusion The anterior approach is a preferred technique for huge right hepatic tumors that are very difficult to resect in the conventional manner.