经腹NHVE切肝术治疗伴有肝硬变的原发性肝癌5例

Liver Resection for Patients with Primary HepaticCarcinoma Accompanied Cirrhosis per Peritoneum Using Normothermic Hepatic Vascular Exclusion (NHVE)—Report of 5 Cases

采用常温下经腹全肝血流阻断技术对5例用一般方法难以安全切除的伴有肝硬变的原发性肝癌病人成功地进行了肝切除。阻断肝门蒂和肝上、下方下腔静脉以阻断全肝血流,阻断时间为4～16min,平均9.6min。切除肝右叶3例、肝左叶1例、肝中叶1例。手术均采用双侧肋缘下屋顶状切口。手术全过程定时监测平均动脉压、脉率、中心静脉压、心电图和尿量,术后2周还定期检测血清转氨酶、乳酸脱氢酶、碱性磷酸酶、血胆红素、凝血酶原时间和肌酐等。结果表明,血液动力学和生化改变不明显,病人耐受良好,术后无并发症出现,均康复出院。

Between March and June 1991, 5 patients with primary hepatic carcinoma accompanied cirrhosis underwent liver resection success- fully per peritoneum using a technique of NHVE in our hospital. The tumors of liver were massive or situated close to or invaded the main hepatic veins or retrohepatic vena cava, it could not be safely resected by conventional methods. The procedure of NHVE was achieved by occlusing the portal triad and supra-and infrahepatic caval vein, its duration was 4～16min with an average of 9.6min. The surgical approach used in all cases was a bilateral subcostal incisionas roof top. Mean arterial pressure, pulse rate, central venous pressure, ECG and urine output was periodically monitored throughout operation in all patients and serum transaminase, LDH, ALP, SB, PT, creatinine and blood air analysis etc was assaied for 2 weeks after operation regularly. The results showed that the hemodynamic and biochemical changes were moderate and the patients tolerance to NHVE is good. All patients survived the surgical procedure and no complications were seen. They were discharged in a good state. The indications and surgical details of the NHVE were discussed also.