25例巨块型原发性肝癌切除体会

Resection of 25 cases with huge hepatocellular carcinoma

目的:探讨巨块型肝癌手术切除的可行性及技术要点。方法:回顾性分析2007年-2012年手术切除的25例巨块型原发性肝癌病例特点、手术方法及预后情况。结果:6例行肝左外叶切除,2例行左半肝切除,3例行肝中叶切除,4例行右半肝切除术,10例行肝叶不规则切除术。手术切除率100%。其中,门静脉切开取栓、门静脉化疗泵植入5例,胆总管切开取栓、胆总管T管引流1例。术中根据肿瘤部位选择性阻断肝脏血流。平均手术时间280±125min,术中出血720±260ml,无手术死亡。术后21例有不同程度腹水,胸腔积液12例,肺不张4例,乳糜漏1例,肝功能衰竭1例。无住院死亡病例。术后随访1年生存率59.6%,3年生存率29.8%,5年生存率19.5%。结论:在严格把握手术适应证前提下,选择合适的肝脏血流阻断方法及断肝方法,保证余肝体积,巨块型原发性肝癌的手术治疗是可行的。

Objective：To investigate the feasibility and technical points of massive primary liver cancer surgical resection of bulky.Methods：A retrospective analysis of massive primary liver cancer cases of 25 patients with surgical resection during 2007-2012 was performed.Results：Six cases underwent hepatic left lateral lobectomy,2 cases left hemihepatectomy,3 cases mesohepatectomy,4 cases right hemihepatectomy,10 cases underwent liver lobe irregular resection.The success rate of surgical resection was 100％.The cases included portal vein cut embolectomy portal vein chemotherapy pump implanted in 5 cases,thrombectomy common bile duct and common bile duct T-tube drainage in 1 case.Selectively block the hepatic blood flow according to the site of tumor.The average operation time was 280 ± 125min,blood loss was 720 ± 260ml,no operative mortality.The postoperative 21 cases have varying degrees of ascites,pleural effusion in 12 cases,4 cases of atelectasis,chylous leakage in 1 case,liver failure in 1 case,no deaths.Follow-up：a year survival rate was 59.6％,three years survival rate was 29.8％,5 years survival rate 19.5％.Condusion：Bulky surgical resection of primary liver cancer is feasible when strictly grasp the operation indication,right liver blood flow blocking methods,suitable cut liver methods and enough remaining liver volume.