间歇性肝门阻断下肝腔静脉结合部肝肿瘤的手术切除及疗效观察

Resection of hepatomas involving the cavohepatic intersection under intermittent portal triad clamping

目的 探讨肝腔静脉结合部肝肿瘤手术切除的方法和疗效。 方法 在间歇性肝门阻断下行肝切除术 ,部分病例预置肝下下腔静脉 (IVC)阻断带 ;切肝先易后难 ,最后处理肝静脉根部 ;全组 6 8例患者术后随访观察患者生存期。 结果 6 8例肝腔静脉结合部肝肿瘤均在间歇性肝门阻断下得到成功切除 ,全组无手术死亡 ,术中出血皆得到妥善处理 ;切除的 6 8例肝肿瘤中 6 5例为原发性肝癌 ,术后 1、2、3和 4年生存率分别为 6 4 11%、5 2 82 %、44 90 %和 36 98% ,其中肿瘤有包膜者术后生存率显著高于无包膜者。 结论 肝腔静脉结合部肝肿瘤可在简单的间歇性肝门阻断下获得安全切除 ,不必常规作复杂的全肝血流阻断 ;

Objective[WT5”BZ] To evaluate the techniques and the results of resecting hepatomas involving the cavohepatic intersection (CHI). [WT5”HZ]Methods[WT5”BZ] Sixty-eight consecutive patients underwent hepatomies for hepatomas involving CHI. The hepatic parenchymal transection was carried out under intermittent portal triad clamping (PTC), with the infrahepatic inferior vena cava (IVC)being encircled with an umbilical tape in some cases. [WT5”HZ]Results[WT5”BZ] All the hepatomas were successfully resected under intermittent PTC, with the infrahepatic IVC being concomitantly occluded in only one case. There was no operative death; the main intraoperative morbidities were hemorrhage from main and short hepatic vein and right adrenal vein, all of which were properly managed. The patients were followed up after operation. In sixty-five patients with primary liver cancer, the 1-, 2-, 3-, and 4-year survival rates were 64 11%, 52 82%, 44 90% and 36 98%, respectively. The patients who had the tumor with capsules survived significantly longer than those who had the tumor without capsules. [WT5”HZ]Conclusions[WT5”BZ] The hepatomas involving CHI can be resected simply under PTC with safety and, therefore, the complicated hepatic vascular exclusion is not necessary in most circumstances. As for primary liver cancer in CHI the tumor with capsule is better indicator for resection than that without capsule. [WT5”HZ]