唇形切肝法用于原发性肝癌外科治疗

LIP SHAPED HEPATECTOMY IN SURGICAL TREATMENT OF PRIMARY LIVER CANCER

目的 陈述唇形切肝法的操作细节并评议此种方法治疗原发性肝癌（ＰＬＣ） 的优点。方法 唇形切肝法是非规则性肝切除术的方法之一。关键在下列５ 个技术环节： ①充分游离肝周韧带； ②设计唇形肝切口； ③切口两侧置缝线牵提； ④楔形断肝和⑤肝断面对缝。结果 笔者单位用此种手术方法治疗了２３３ 例ＰＬＣ 患者，其中８ 例因肿瘤复发接受了两次肝切除手术。手术死亡率为１ ．２ ％ ，２ 例死于肝功能衰竭，１ 例死于肾功能衰竭。除３ 例胆漏、１ 例手术区积液外，未见腹腔内出血、膈下感染等严重合并症发生。２３３ 例患者１ 、３ 、５ 年生存率分别为８９ ．８ ％ 、６４ ．３ ％ 和５５ ．９ ％ ，２５例生存超过５ 年。其结果提示：本手术方法的优点是在兼顾切除彻底性的同时，大大提高了手术的安全性，特别是减少了来自肝断面的合并症。结论 唇形切肝法是一种相对简便、安全、合理的肝切除模式。

Objective To state operative details of lip shaped hepatectomy (LSH) and evaluate its advantage in treatment of primary liver cancer (PLC). Methods LSH is one of the irregular hepatectomies. The key lies in the following five operative kinks: ①adequately mobilizing perihepatic ligaments; ②designing lip shaped hepatic incision; ③laying sutures on both sides of the hepatic incision for traction; ④wedge shapedly resecting the tumor and the surrounding liver; ⑤closely sewing up the hepatic cutting surface.Results Two hundreds and thirty three patients with PLC were treated by LSH between Oct. 1991 and Dec. 1997 in Zhongshan hospital, Shanghai medical university. Among them 8 cases underwent initial hepatectomy and resection for recurrence of the tumor. The operative mortality rate was 1.2%, 2 died of hepatic failure and 1 renal failure. In addition to bile leakage in 3 cases and hydropsy at the operative area in one case, no severe postoperative complications were found, such as intraperitoneal bleeding, subphrenic abscess and so on. The 1 ,3 ,5 year survival rates were 89.8%, 64.3% and 55.9% respectively, in 233 patients with 241 LSHs. 25 patients survived more than 5 years. The result indicated that the most advantage of LSH was to increase operative safety on the basis of guarantee of radical resection of PLC, especially to decrease some complications from hepatic cutting surface. Conclusion LSH is a relatively simple, safe, reasonable and recommendable hepatectomic modality.