复杂巨大肝肿瘤的精确切除体会(附52例报道)

Precise Liver Resection for Giant Complex Hepatic Neoplasm:Report of 52 Cases

目的总结复杂巨大肝肿瘤的精确切除经验。方法 2008年4月至2009年8月期间四川大学华西医院肝胆胰外科行复杂巨大肝肿瘤精准切除52例,术前仔细进行肝脏储备功能、肝脏影像学等评估,术中选择适当的手术入路、血流阻断方式、断肝新技术、结合术中B超等方法。结果本组病例平均手术时间为350 min（210~440 min）,半肝血流阻断时间平均为43 min（8~57 min）,术中平均出血量为370 ml（250~1 150 ml）,谷丙转氨酶恢复正常平均时间为10 d（7-14 d）,总胆红素恢复正常平均时间为4.5 d（3-10 d）;术后并发症发生率低,仅6例出现轻度漏胆,无肝功能衰竭等重大并发症,无死亡病例。结论精准肝切除治疗复杂巨大肝肿瘤安全、可行。

Objective To summarize the experiences of precise liver resection for giant complex hepatic neoplasm.Methods Fifty-two cases of giant complex hepatic neoplasms were resected using precise liver resection techniques from April 2008 to August 2009.Hepatic functional reserve and liver imaging were evaluated before operation.Appropriate surgical approach,half-hepatic blood flow occlusion,new technique of liver resection,and intraoperative ultrasonography were applied during operation.Results The mean operative time,half-hepatic blood occlusion time,blood loss,recovery of alanine aminotransferase,and total bilirubin were 350 min（210-440 min）,43 min（8-57 min）,370 ml（250-1 150 ml）,10 d（7-14 d）,and 4.5 d（3-10 d）,respectively.Only 6 patients had mild bile leakage.No liver failure and other major complications emerged,and no death happened.Conclusion Precise liver resection is a safe and effective approach for giant complex hepatic neoplasm.