深部微小肝癌术中超声导引下经肝穿刺美蓝定位与切除

Resection and localization of micro hepatocellular carcinoma in the deep liver panrenchyma by injection of methylene blue guided by intraoperative ultrasound

目的探讨术中超声引导下美兰染色在深部微小肝癌的手术定位及切除方法。方法对2011年8月-2014年2月入住我院临床确诊的肝深部微小肝癌患者13例,术中应用Aloka 5000型超声仪,探头（频率5 MHz）直接置于肝脏表面进行超声检查,确定微小肝癌的大小、形态,并在超声导引下经肝穿刺注射美兰于肿瘤表面,并实施距肿瘤边缘1-2cm的不规则肝部分切除术。结果 13例患者均合并有肝硬化,均无法通过触诊发现病灶。术中超声均准确的定位病灶的位置、大小及形态,并成功的经肝穿刺注射美兰至肿瘤表面,并根据美蓝定位顺利找到肿瘤,实施手术切除,术后恢复良好。结论合并有肝硬化的肝实质深部微小肝癌行术中超声引导下经皮肝穿刺美蓝染色,定位准确;保证切缘阴性的不规则肝部分切除能保留更多的正常肝组织,减少手术时间及出血量,减轻对肝功能的损害。

Objective To study the localization of micro hepatocellular carcinoma in the deep liver panrenchyma by injection of methylene blue guided by intraoperative ultrasound and surgical technique. Methods 13 cases of micro hepatocellular carcinoma located deeply in the liver panrenchyma were admitted in our hospital from August 2011 to February 2014. Aloka 5000 type ultrasound（probe frequency of 5 MHz） was used during the operation. The probe was put directly on the surface of the liver to detect the size and shape of the tumor. Methylene blue was injected in the surface of the tumor guided by the ultrasound. And irregular liver resection of1 - 2cm away from the tumor margin was implemented. Results All of the 13 patients were complicated with liver cirrhosis. The lesion cannot be found by palpation in the operation. Intraoperative ultrasound accurately positioned the location,and detected the size and shape of the lesions. And methylene blue was successfully injected into the surface of the tumors. The tumors were found and resected easily according to the methylene blue location. All the patients recovered well after operation. Conclusion Micro hepatocellular carcinoma in the deep cirrhotic liver could be accurately located by injection methylene blue into the surface of the tumors guided by the intraoperative ultrasound. Under the condition of negative cutting margins,irregular partial hepatectomy could retain more normal liver tissue,reduce surgical time and blood loss,and mitigate liver damage.