肝尾叶肝癌28例的手术切除体会

Resection of caudate lobe carcinoma of the liver

目的 总结肝尾叶肝癌的手术切除技术及效果。方法 分离结扎切断肝短静脉 ,使肝后下腔静脉与癌灶完全分离 ,针对不同部位癌灶采用不同入路 ,局部或联合肝叶切除尾叶肝癌。结果 本组 2 8例尾叶部肝癌均顺利切除 ,其中 16例采用第 3肝门解剖法切除。每例结扎肝短静脉 2～5支 ,平均 3支 ,平均第 1肝门阻断时间为 2 1 7min ,术中平均出血 5 74ml,未发生大出血及胆汁漏等严重并发症。本组于术中行全肝血流阻断 5例。术后均痊愈出院 ,定期肝动脉插管化学药物治疗 ,术后复发或肝外转移者 13例 ,其中已死亡 5例。结论 采用第 3肝门阻断法切除肝尾叶部肝癌可减少术中大出血机会 ,提高了肝尾叶肝癌的切除率。

Objective To analyse the operative technique and results of the resection of the caudate lobe carcinoma of the liver.[WT5”HZ]Methods[WT5”BZ] The liver was fully freed of the ligments, short hepatic veins were divided and sutured, and the tumor was then freed from the inferior vena cava(IVC).The caudate lobe was resected alone or in combination with other segment.[WT5”HZ]Results[WT5”BZ] 28 patients underwent caudate lobe tumor resection. The number of short hepatic veins transected and tied was 2～5 (mean 3).An intermittent Pringle′s manoeuver was used in all of the patients with a median occlusion time of 21 7(range 10～32)*!min. The median blood loss was 574(range 100-1*!300)*!ml. There were no major complications such as massive bleeding and biliary fistula.Intraoperative total blood flow occlusion was used in only 5 cases.All patients were discharged from the hospital.Outpatient periodic TAE plus chemotherapy was performed. Postoperative recurrence and metastasis was found in 13 cases,with 5 deaths.[WT5”HZ]Conclusions[WT5”BZ] The use of third porta hepatis dessection for resection of the caudate lobe tumor can reduce the risk of massive bleeding during the operation and can raise the rate of resection of caudate lobe tumor. [WT5”HZ]