肝段显色技术在解剖性肝切除中的应用价值

Application of hepatic segment coloration technique in anatomical hepatectomy

目的探讨肝段显色技术联合应用在解剖性肝切除中的价值。方法回顾分析2018年1月至2018年11月解放军总医院第一医学中心肝胆外科收治的19例采用肝段显色技术进行解剖性肝段切除的肝细胞癌病人的临床资料,采用以持久美蓝染色法为主结合超声引导下肝段门脉穿刺染色以及Glisson蒂横断技术来施行解剖性肝段切除手术。结果肝段显色成功率为100%。19例病人均行解剖性肝段切除,包括S5 2例,S6 2例,S7 2例,S8 3例,S4b 1例,S8v 2例,S8d 2例,S5+S8v 2例,S5+S8d 2例,S6+S5d 1例。手术时间为(178±48) min,术中出血量为(256±106) ml,术后住院时间为(8±1) d,无病例术中输血,无严重并发症发生。结论肝段显色技术的联合应用可以提高肝段显色成功率,同时在肝实质离断过程中对切面选择具有引导作用,其可有效降低手术技术难度,可重复性高,利于临床进一步推广。

Objective To investigate the clinical value of hepatic segment coloration technique in anatomical hepatectomy.Methods The clinical data of 19 patients with liver cancer who received precise hepatectomy after hepatic segment coloration technique at General Hospital of PLA from January to November in 2018 were retrospectively analyzed.Anatomical hepatectomy was performed with persistent methylene blue dyeing method combined with ultrasound-guided portal vein puncture staining and(or)Glissonean pedicle transaction method.Results The hepatic segment coloration technique was successfully carried out in all patients.Anatomical hepatectomy were performed,including 9 cases of segmentectomy,5 cases of subsegmentectomy,and 5 cases of multi-segmentectomy or multi-subsegmentectomy.The mean operation time and blood loss was(178±48)min and(256±106)mL respectively.There were no intraoperative blood transfusion and no serious complications.Conclusion The hepatic segment coloration technique has the advantage of high success rate,and also can guide the selection during parenchymal transection.This technique can effectively reduce the difficulty of surgical technique and has high repeatability,which is conducive to further clinical promotion.