极限量肝切除治疗巨大肝癌的安全性分析

Analysis on safety of extended lobectomy for huge primary hepatic carcinoma

目的探讨巨大肝癌患者行肝切除的安全性评价指标。方法回顾性分析7年间手术治疗的69例巨大原发性肝癌患者的临床资料,综合分析评估巨大肝癌肝切除的术前肝功能、肝储备功能、肝切除量、残肝体积等指标,观察患者术后恢复及生存情况。结果全组术前肝储备功能ICGR15均在≤15%,术前估计解剖性肝切除量在50%～70%。43例接受根治性切除,26例为姑息性切除。切除术后1个月内死亡3例,手术病死率为4.4%,术后并发症发生率为27.5%,经治疗后均顺利恢复。结论肝储备功能评估结合计算机辅助的肝体积精确测量,为确定肝切除安全限量和适当肝切除范围提供了可靠依据。[中国普通外科杂志,2011,20(1):20-22]

Objective To investigate the safety of extended hepatic lobectomy for huge primary hepatic carcinoma（HPLC）.Methods A retrospective analysis was made on the clinical data of 69 patients with HPLC who underwent extended lobectomy in our hospital within the recent 7 years.The data included preoperative liver functional reserve,liver resection volume,remnant liver volume and postoperative recovery and survival.Results Preoperatively,ICGR15 was≤15% in all the patients,and the estimated anatomic liver resection volume was 50% to 70%.Forty-three patients received radical liver resection and 26 palliative resection.Three patients died within 1 month after operation;the operative death rate was 4.3%.Postoperative complications occurred in 27.5% of the patients,but all recovered after treatment.Conclusions Assessment of hepatic functional reserve combined with accurate computer-aided measurements of liver volume can provide a reliable basis to determine the safe resected volume and proper limit of liver resection.