小儿肝脏巨大肿瘤精准切除30例分析

Precise liver resection for giant pediatric hepatic neoplasm： a report of 30 cases

目的对四川大学华西医院近3年开展的30例小儿肝脏巨大肿瘤精准切除病例进行总结分析。方法2009年1月至2012年2月小儿外科共实施肝脏巨大肿瘤精准切除30例，男17例，女13例，年龄2个月～14岁，平均（5．04±3．50）岁。其中肝母细胞瘤13例，肝脏局灶性增生5例，肝血管瘤3例，肝错构瘤3例，其他6例。所有病例术前进行肝脏储备功能及影像学的仔细评估，术中采用先进的手术方法及器械精细断肝，并将其治疗效果与传统肝切除法进行比较。结果精准肝切除组失血量（193．oo±103．76）ml及输血量（210．83±133．66）ml显著少于传统肝切除组的（358．60±192．56）ml和（436．80±282．75）ml（P〈0．01）；谷丙转氨酶及总胆红素平均恢复时间分别为（8．13±1．74）d和（6．50±1．87）d，明显短于传统肝切除组的（10．80±2．81）d和（8．96±3．21）d（P〈0．01）；ICU滞留时间及住院时间为（2．12±0．68）d和（11．43±1．92）d，也短于传统肝切除组的（2．56±1．36）d和（14．52±3．94）d（P〈0．05）。精准肝切除组患儿术后并发症率33．3％，低于传统肝切除组76．0％，术后无死亡、肝功能衰竭、腹腔内大出血及腹腔感染发生，仅有10例患儿出现轻度胆漏、胸腔积液及肺部感染。结论精准肝切除是治疗小儿巨大肝脏肿瘤安全有效的方法。出血量少，肝功能恢复快，术后并发症率低，住院时间短。

Objective To summarize our experience on precise liver resection for giant pediatric hepatic neoplasms. Methods From January 2009 to February 2012,30 patients underwent precise liver resection technique for resection of giant hepatic neoplasm at West-China hospital of Sichuan Universi- ty. The patients,consisting of 17 boys and 13 girls,had an average age of 5.04 ＋ 3.50 years （range,2 months to 14 years）. Hepatic reserve function and radiologic study were evaluated carefully before sur- gery. Individualized surgical approach was carefully planned. Postoperative pathology diagnoses were hepatoblastoma in 13 ,focal liver hyperplasia in 5, hepatic hemangioma in 3, liver hamartoma in 3, and other in 6. The outcome of precise liver resection technique was evaluated by comparing with the out- come of conventional liver resections. Results Compared with conventional liver resection, patients un- derwent precise liver resections had less mean blood loss and blood transfusion （P~ 0. 01）, faster de- cline in alanine aminotransferase, sooner recovery in total bilirubin levels （P~ 0. 01）, and shorter ICU/hospital stays （P~ 0. 05）. The precise liver resections were associated with fewer complications than conventional liver resection. No liver failure, intra-abdominal bleeding, abdominal infection, or death was noted. Ten patients had minor complications, including mild bile leakage, hydrothorax, and pulmonary infection. Conclusions Precise liver resection is safe and effective for the treatment of giant hepatic neoplasms in children.