膈肌切除在肝癌合并膈肌侵犯手术中的应用

Clinical Application of En Bloc Resection of Diaphragm for Hepatocellular Carcinoma with Gross Diaphragmatic Involvement

目的介绍膈肌整块切除在肝细胞癌合并膈肌侵犯手术中的应用,评估其安全性及可行性。方法对桂林医学院附属医院肝胆外科2008年8月-2011年8月收治的13例肝细胞癌合并膈肌侵犯患者,行手术切除整块受累膈肌及癌组织,膈肌缺损处采用鼓肺排气一期缝合。结果手术过程顺利,手术时间80～220 min,术中出血量85～450ml,术后病理均提示手术切缘阴性,无围手术期死亡,其中11例术后出现少量胸腔积液,2例中等量积液,经B超引导胸腔穿刺引流术后治愈,术后平均住院10.1 d。所有患者术后均定期随访,平均随访15.2(4～30)个月,其中6例于术后复发死亡,4例术后复发但仍在治疗中,余3例至今未复发。结论膈肌整块切除在肝癌合并膈肌侵犯手术中的应用是安全、可行的,其操作简单,术中出血少,远期疗效确切。

Objective To introduce the clinic application of en bloc resection of the diaphragm in the patients with hepatocellular carcinoma with gross diaphragmatic involvement.Methods During Aug.2008 to Aug.2011,13 patients with hepatocellular carcinoma which invaded diaphragma underwent en bloc resection of the diaphragm and hepatectomy,the defective diaphragma were primary sutured.Results All operations were completed smoothly,the operation time was 80-200 min,the bleeding was 85-450 ml.Postoperative pathology indicated the operative margin were clean in all cases.There was no perioperative death.11 cases suffered a small quantity of pleural effusion post-operation,2 cases with medium dose of pleural effusion cured by transcutaneous draining under ultrasonography.Mean time of postoperative hospitalization was 10.1 days.The follow-up（mean time 15.2 months） in all cases showed that 6 cases died from tumor recurrence,4 cases were with recurrence but still under the follow-up now.Conclusion En bloc resection of the diaphragm for the patients with hepatocellular carcinoma with gross diaphragmatic involvement is safe and feasible for the patients with hepatocellular carcinoma which invaded diaphragm,and it is simple on the technique,which has lower complications in operative and postoperative.