肝正中裂劈开切除中央型肝癌1例报告并文献复习

Central hepatocellular carcinoma resection via separation of middle hepatic fissure: a report of one case and review of literature

目的:探讨中央型肝癌肝切除术的术前评估及手术方法。方法:回顾性分析1例VIII段深部中央型肝癌手术切除的临床资料,并复习相关文献。结果:术前对患者行精确的肝功能及肿瘤情况评估、进行周密的手术规划。术中沿肝正中裂劈开肝实质,上达第二肝门,下至第一肝门,再沿肝右静脉走行位置切开肝实质与劈开的肝正中裂汇合,然后沿肿瘤包膜完整切除肿瘤,并完整保留肝右静脉和肝中静脉。术后CT复查显示肝右静脉和肝中静脉回流通畅。结论:中央型肝癌手术难度大,风险高,术前充分评估及选择合适的手术方式是手术成功的关键。

Objective： To investigate the preoperative evaluation and surgical methods for central hepatocellular carcinoma. Methods： The clinical data of a patient with primary hepatocellular carcinoma located in deep position of segment VIII was analyzed retrospectively, and relevant literature review was also made. Results： Before operation, accurate liver function assessment and precise tumor localization, and then careful surgical planning were made for this patient~ during operation, the liver parenchyma was split along the median fissure of the liver from the second porta hepatis at its superior plane to the first porta hepatis at its inferior plane, and then, liver parenchyma was separated along the line of the right hepatic vein, and was converged with the divided median fissure of the liver, after which, the tumor was completely excised with complete preservation of the right and middle hepatic veins. Postoperative CT examination showed that the right and middle hepatic veins were patent. Conclusion： Surgery for central hepatocellular carcinoma is difficult and has high risk. Adequate preoperative evaluation and appropriate selection of surgical methods are critical for surgical success.