肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除手术的安全性探讨

Hepatic Ⅶ-Ⅷ bisegmentectomy with concurrent resection of right hepatic vein for liver tumors

目的肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除作为新的手术方式，替代右半肝切除，治疗位于肝脏Ⅶ-Ⅷ段侵犯肝右静脉的肿瘤。探讨肝脏Ⅶ-Ⅷ段联合肝右静脉切除的可行性、安全性。方法回顾性分析13例肝脏Ⅶ-Ⅷ段肿瘤侵犯肝右静脉，行肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除的手术情况，术后恢复及预后。结果全部13例患者均安全施行肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除，未重建肝右静脉。手术耗时90～215min；出血100～700ml。术后病理显示肝细胞癌6例，肝内胆管细胞癌1例，肝转移癌4例，肝海绵状血管瘤2例。全组13例术后均顺利恢复，无严重合并症发生。3例出现第Ⅵ段血运障碍，实质萎缩，但无肝功能异常。结论不重建肝右静脉的肝脏Ⅶ-Ⅷ段联合肝右静脉切除安全可行。

Objective Bisegmentectomy Ⅶ-Ⅷ can be an alternative option for the tumor localized in segments VII and vm and infiltrating the main trunk of RHV instead of a right hemihepatectomy. This study was to evaluate the safety and practicability of the removal of segments Ⅶ and Ⅷ of the liver with the resection of the main trunk of RHV without vascular reconstruction. Method 13 consecutive patients underwent bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV between Nov. 2006 and Dee. 2012 at Beijing Cancer Hospital 1st Department. of HPB Surgery. Results Bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV was performed in all 13 patients successfully without the distal vein reconstruction. The duration of the operations was 90 -215 min. Mean blood loss was estimated to be 200 ml （100 -700 ml）. Indications for a bisegmentectomy Ⅶ-Ⅷ included hepatocellular carcinoma in 6 cases, intrahepatie cholangiocarcinoma in one, liver metastasis in 4 and hepatic hemangioma in 2 as confirmed pathologically. All patients recovered without severe complications. The atrophy of segment Vl due to the venous drainage obstacle was observed in 3 patients without the dysfunction of liver postoperatively. Conclusions It is safe and practicable to perform Ⅷ and WI bisegmentectomy with resection of the right hepatic vein without vascular reconstruction for liver tumors.