肝蒂横断法解剖性肝段切除治疗肝癌的临床研究（附36例报告）

Anatomical subsegrnentectomy with Glissonean pedicle transection method for hepatocellular carcinoma： a report of 36 cases

目的总结肝蒂横断法解剖性肝段切除治疗肝细胞肝癌（肝癌）的安全性及疗效。方法回顾性分析2009年6月至2011年2月我们应用肝蒂横断法解剖性肝段切除治疗36例肝细胞肝癌患者的临床资料。结果36例肝癌患者均顺利完成肝蒂横断法解剖性肝切除，无术中死亡。术中平均出血量为320ml（80～1000m1），其中80．5％（29／36）不需输血。肿瘤平均最大直径7．6cm（3～20cm）。术后30d内无手术死亡，术后并发症发生率为20％，无出血、肝功能衰竭等严重并发症。术后平均住院时间12d，1年复发率为13．8％，1年生存率为86．1％。结论肝蒂横断法解剖性肝段切除术治疗肝癌安全可行，提高了手术根治率。该方法简单，易于掌握，无需使用昂贵的特殊器械，值得推广应用。

Objective To explore the safety and efficacy of anatomical subsegmentectomy with Glissonean pedicle transection method for hepatocellular carcinoma （ HCC ）. Methods Thirty - six pa- tients with HCC were subjected to anatomical subsegmentectomy with Glissonean pedicle transection meth- od in our department from June 2009 to February 2011, and their clinical data were analyzed retrospective- ly. Results All of the surgeries were successful and there was no intraoperative death. Mean intraoperative blood loss was 320 ml （80 ~ 1000 ml）, and 80.5 % （29/36）of the patients did not require blood transfu- sion. The average size of the biggest tumor was 7.6 cm in diameter（3 ~ 20 cm）. The postoperative compli- cation rate was 20%, and there was no serious bleeding or liver failure. Mean postoperative hospital stay was 12 days. One - year postoperative recurrence rate was 13.9% and one - year mortality was 86.1%. Conclusion Anatomical subsegmentectomy with Glissonean pedicle transection method for HCC is safe and feasible, and increases eradication rate. This method is simple, easy to learn and needs no special or expensive instrument, which is worth of popularization and application.