非规则肝切除治疗原发性肝癌

Non-regular hepatectomy to treat primary liver cancer

目 的 探讨原发性肝癌行非规则切除的处理方法．方法 在近８年中对１０３例肝癌行非规则肝切除，术式包括联合段切除、部分肝段切除、联合右前后叶部分切除、左内叶楔形切除及左右半肝切除、左三叶肝切除等。对中央型（Ⅳ、Ⅴ、Ⅷ段）肝切除，由于其于第一、二肝门的关系密切，紧贴或累及大血管，切除时应预置血管阻断带。Ⅷ段切除时应注意至少保留肝中或肝右静脉一支，以利肝静脉回流。肝断面处理提倡尽可能对拢缝合。结果 无手术中死亡。９１例痊愈，３例因肝硬变严重术后１５ｄ内死于肝衰，８例有不同程度胸腹水和肺部感染．随访８２例，１、３、５年生存率为６２．２％、２５．６％和１２．２％．结论 非规则肝切除毋需解剖肝门，手术步骤简化，便于普及且对合并肝硬变者可以减少切肝量，利于防止肝衰，减少并发症。

Objective To study the operative methods of non-regular resection to treat primary liver cancer. Methods 103 patients had undergone non-regular resection during the last 8 years in our hospital. Operative methods included:combined hepatic segments resection,part hepatic segments resection.combined right prior and posterior lobectomy of part liver,left inerior lobectomy of liver,left and right lobectomy and left three lobectomy and so on. Vascular blocking belt was performed preventively when segments Ⅳ,Ⅴ,Ⅷ resection was carried out, because the segments are near the first and second hepatic portal and close or infiltrate greater vascular. When segment Ⅷ was resected at least a branch of middle veins or right hepatic veins should be reserved to ensure hepatic veins back flow. Hepatic cross section should take pains to suture. Results There was no patient died intraoperation. 91 cases were cured, 3 cases died of hepatic failure 15 days after operation for serious hepatocirrhosis, 8 cases had hydrothorax and ascites of different degree. 82 cases were followed-up,survival rate of 1, 3 and 5 yers were 62.2%. 25. 6% and 12. 2% respectively. Conclusion Non-reguar liver resection need not dissect hepatic portal, the operative method is simple and easy to be popularized. For patients with hepatocirrhosis,tbe operative method may decrease the amount of resected liver,prevent liver failure and decrease complications.