持久亚甲蓝染色法在肝细胞癌合并胆管癌栓解剖性肝切除术中的应用

Application of persistent methylene blue dyeing method for anatomic hepatotectomy of hepatoceHular carcinoma with bile duct tumor thrombi

目的探讨持久亚甲蓝染色法在肝细胞癌合并胆管癌栓患者的解剖性肝切除术中的应用价值。方法2009年1月至2011年2月对11例肝细胞癌合并胆管癌栓患者实施解剖性肝切除术和胆管取癌栓术。其中男性10例，女性1例；年龄31～67岁，平均年龄49岁。9例以黄疸为首发临床表现。按Satoh分型Ⅰ型3例，Ⅱ型7例，Ⅲ型1例。在肝门部解剖出预切除肝段的蒂，向Glisson鞘内门静脉远端注射亚甲蓝后结扎该蒂，使预切除肝段染色，按着色的界限行肝段切除。结果11例手术均染色成功，实施肝段切除4例，肝亚段切除3例，半肝切除2例，肝叶切除2例。平均手术时间137min，平均术中出血量246ml。术后均无肝功能不全等严重并发症发生，无围手术期死亡。平均随访14．6个月，2例出现肝脏肿瘤复发，1例发生肿瘤腹腔种植，1例复发胆管癌栓，2例死亡。结论采用持久亚甲蓝染色法肝切除术治疗肝细胞癌合并胆管癌栓能提高肝切除的精准性。

Objective To evaluate the role of anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method. Methods From January 2009 to February 2011, 11 hepatocellular carcinoma patients with bile duct tumor thrombi underwent anantomic hepatotectomy with removal of the biliary tumor thrombus. There were 10 male and 1 female patients. The average age was 49 years （ranging from 31 to 67 years）. The initial symptom of 9 out of the 11 patients was jaundice. After anatomy and ligation of Glissonean pedicle of pre-resection segment, methylene blue was injected into its far-end portal vein in order to dye the segment. Results Persistent methylene blue dyeing method was successful in all patients. Primary loci were found in all patients. Hepatotectomy were performed, including 4 patients of segmenteetomy, 3 patients of subsegmentectomy, 2 patients of hemihepatectomy, and 2 patients of hepatic sectoreetomy. The mean operation time and blood loss was 137 minutes and 246 ml respectively. Severe complications such as liver function failure and sub-diaphragm abscess was avoided in all patients. No perioperative death. Post-operation radiotherapy was performed on 2 patients. Over a mean follow-up time of 14.6 months, liver cancer recurrence occured in 2 patients, abdomen seeding metastasis in 1 patient, bile duct tumor thrombi recurrence in 1 case, and 2 patients died. Conclusions Anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method can make resection more precise and improve curative effect.