无血切肝术在肝肿瘤切除49例中的应用

The use of non-bleeding technique for the resection of hepatoma: report of 49 cases

目的 根据我们 1988～ 1998年实施无血切肝术的经验 ,结合近年来的研究成果 ,探讨与手术有关的一些问题。方法 常温下全肝血流阻断 47例、低温灌注全肝血流阻断 1例、半离体 1例。结果 术中出血量 (15 6 0± 12 5 2 )ml,手术时间 (4 7± 0 8)h ,手术死亡 1例。随访 39例 ,其中良性肿瘤病例均长期生存 ,31例原发性肝癌和转移性肝癌患者半年、1年和 3年生存率分别为 77% (2 4/31)、5 5 % (17/31)和 36 % (11/31)。结论 (1)在肝门区肿瘤的切除中 ,Pringle法仍是主要的控制出血方法 ;(2 )若肿瘤侵犯腔静脉和肝静脉 ,一般可通过常温下全肝血流阻断解决 ;(3)半离体切肝术可实现对腔静脉后方的暴露 ,若肿瘤侵犯腔静脉方可采用此法。 (4 )术中B型超声在肝切除止血方法的选择中有重要价值。

Objective[WT5”BZ] To investigate the skill-related experience for the non-bleeding hepatectomy. [WT5”HZ]Methods[WT5”BZ] 49 patients of hepatic tumors were reported, including 41 cases of primary hepatic carcinoma, 3 of secondary hepatic carcinoma, 4 of haemangioma and 1 of hepatic adenoma. Three kinds of bleeding controll technique including normothermic complete hepatic vascular occlusion (47/49), complete vascular isolation with hypothermic perfusion (1/49) and partial extracoporeal hepatectomy (1/49) were employed.[WT5”HZ]Results[WT5”BZ] The intraoperative blood loss was 1*!560±1*!252*!ml, and operative time 4 7±0 8*!h.One case died on table because of severe bleeding. 31 patients were followed up, the 0 5, 1, and 5-year survival rate were respectively 77%(24/31)、55%(17/31) and 36%(11/31).[WT5”HZ]Conclusions[WT5”BZ] In the hepatectomy for tumors involving in CouinaudⅠ, Ⅳ, Ⅴor Ⅷ, Pringle′s procedure is still the major method for bleeding control. When the tumor has implicated the cava inferior or/and venae hepaticae, normothermic complete hepatic vascular occlusion is helpful. The partial extracoporeal technique can provide a good exposure to the cava inferior, and is an alternative to the complete extracorporeal method. Intraoperative ultrasound plays an important role in the determination of bleeding controll technique. [WT5”HZ]