紧贴肝门大血管的肝癌手术并发症的防治

Control of complications in resection of liver cancer closed to major vessel of hepatic hila

目的 探讨已累及肝内主干血管的肝癌手术经验 ,防止并发症与提高术后疗效。方法 将近 10年来手术切除的肝门区肿瘤病人中 ,选择了紧贴肝内大血管 1cm以内的肝癌 78例 ,肿瘤直径≤ 5cm 2 1例 ,>5cm 5 7例 ,最大者为 2 0cm× 2 0cm× 18cm ,对术中如何防治并发症发生等进行总结分析。结果 术中并发大出血、术后胆瘘、伤及健侧肝门发生率分别为 8 9% ,3 8%和 1 2 % ,无手术死亡。结论 虽然此类手术难度大、风险大 ,只要重视手术适应证选择、手术方法改进 ,仍可提高手术安全性 ,防止并发症的发生。

Objective To study the operative experience and methods to control the complications while resecting the liver cancer closed to the major vessels of hepatic hila. Methods In 78 cases, the liver cancers locating in segments Ⅰ, Ⅳ,Ⅴ, Ⅶ and Ⅷ were resected. The diameter of the cancer was over 5 cm in 57 cases. The size of the largest cancer was 20 cm×20 cm×18 cm. The operative methods, estimation of the resection possibility and the way to control the complications were summarized and analyzed. Results During the operation, the occurring rates of massive hemorrhage, biliary fistula and contralateral liver hila injury were 8.9%, 3.8% and 1.2%, respectively and no patients died in the surgery. The 1-, 3- and 5-year survival rates were 69.8%, 35.6% and 21.45%, respectively. Conclusions Though performance of this surgery is quite difficult and risky, safety of the operation can be improved and complications controlled by paying attention to the suitable choice of cases and improvement of surgical technique.