肝中叶切除术的临床应用

Clinical application of mesohepatectomy

目的探讨肝中叶切除术的可行性和安全性。方法回顾分析我科2003年1月至2012年2月间行肝中叶切除或改良肝中叶切除术的22例患者的临床资料。结果本组中央区肝脏肿瘤17例,肝门部胆管癌者3例(均为BismuthⅣ型),胆囊癌2例(均为TNM分期Ⅳa期)。其中行肝中叶切除术17例,均为肝中央区肿瘤患者;行改良肝中叶切除术5例,同时行肝外胆管切除、区域性淋巴结清扫术和胆肠内引流术,包括3例肝门部胆管癌患者(附加Ⅰ段切除术)和2例胆囊癌患者。手术时间198～241 min,平均(205±139)min;术中出血量300～2 100 mL,平均(630±270)mL。无围手术期死亡,术后并发症发生率为31.8%(7/22)。结论在术前充分准备的情况下,选择适当的肝脏血流阻断技术、术中仔细操作,肝中叶切除术或改良肝中叶切除术是安全可行的。

Objective To explore the feasibility and safety of mesohepatectomy. Methods The clinical dataof 22 patients underwent mesohepatectomy or modified mesohepatectomy during Jan. 2003 and Feb. 2012 were retrospectively reviewed. Results There were 17 centrally located hepatic tumors, 3 hilar cholangiocarcinomas （all were Bismuth type Ⅳ）, 2 gallbladder cancers （all Ⅳ stage of TNM ）. In 22 cases, 17 patients with centrally located hepatic tumors underwent mesohepatectomies, the remaining 5 patients underwent modified mesohepatectomies combined with resection of extrahepatic bile duct, regional lymph node dissection and hepaticojejunostomy. For patients with hilar cholangiocarcinomas, the resection of caudate lobe was performed. The duration of operation ranged from 198 to 241 min with mean time of （205± 139） min. The volume of blood loss during operation ranged from 300 to 2 100 mL with mean volume of （630 ±270） mL. There was no perioperative death, and the rate of postoperative complication was 31.8 % （7/22）. Conclusion Mesohepatectomy or modified mesohepatectomy is safe and feasible with appropriate preoperative evaluation and preparation and proper selection of liver vascular exclusion during operation.