婴幼儿肝脏肿瘤行精准肝切除术的临床效果及体会

Clinical outcomes of partial hepatectomy and management experience in pediatric hepatic cancer patients

目的探讨婴幼儿肝脏肿瘤施行精准肝部分切除术的临床效果、手术操作的技术关键、手术适应证及并发症的预防。方法回顾分析2009年11月至2011年10月间行精准肝部分切除术12例患者的临床病历资料。结果成功完成精准肝部分切除术1 2例,肿瘤平均大小8 cm,平均手术时间40 min(30～80 min),术中出血量25 ml(10～40 ml),术后住院时间8 d(7～9 d)。术后第2 d即可进食,复查1次血常规均无明显变化,引流管均未见明显引流液,均于术后第2 d拔除。无术后并发症。术后病理诊断肝母细胞瘤8例、肝毛细血管瘤2例、肝错构瘤2例。随访1个月到2年,无肿瘤复发。结论为婴幼儿施行精准肝部分切除术是安全可行的,具有创伤小、恢复快、并发症少等优点,是治疗婴幼儿肝脏肿瘤的安全有效的手术方式。

Objective To perform a retrospective analysis of curative effect and complications associated with partial hepatectomy in pediatric patients treated for liver tumors at our hospital.Methods The clinical records of 12 pediatric patients,ranging in age from 5 to 34 months,who underwent partial hepatectomy from December 2009 to October 2011,were reviewed retrospectively.Data extracted for analysis included preoperative symptoms,perioperative management and operative method,postoperative management,complications,survival,and follow - up findings.Results The partial hepatectomy was performed successfully in all 12 cases.The average tumor size was 8 cm.The average operation time was 40 min（range：30-80 min）,and the average intraoperative blood loss was 25 ml（range：10 - 40 ml）.The mean length of hospital stay was 8 days（range;7-9 days）.None of the cases had obvious fluid in the drainage tube when removed at day 2 after surgery.All patients were discharged without complications.Pathological diagnosis identified eight hepatoblastomas,two hepatic hemangiomas, and two hamartomas.No tumor reoccurrence was detected during follow - up（range;1 month to 2 years）.Conclusion Partial nepatectomy is a safe and effective treatment for liver tumors in pediatric patients.This surgical procedure is associated with minimal trauma, rapid recovery and few complications,and may be a feasible treatment option for early childhood liver cancer.