邻近主肝静脉根部肝肿瘤的手术治疗

HEPATECTOMY FOR TUMORS ADJACENT TO THE ROOT OF HEPATIC VEIN

①目的 探讨邻近主肝静脉根部肝肿瘤切除的可能性。②方法 分析我院近 3年经手术切除的累及主肝静脉根部肝肿瘤病人 35例的临床资料。其中原发性肝癌 2 2例 ,并发肝硬化 12例 ;肝血管瘤 11例 ;肝细胞局限性增生 1例 ;肺癌肝转移 1例。③结果 行左半肝切除 +Ⅷ段切除术 10例 ,左半肝切除术 2例 ,Ⅷ段切除或部分切除术 5例 ,肝Ⅶ段和Ⅷ段切除术 10例 ,肝中叶切除术 8例。 9例肝中静脉主干结扎或切除 ,1例直接吻合 ,1例肝右静脉干因出血而切除 ,1例肝右静脉结扎。全肝血流阻断 8例。术后出现中等量腹水 2例和胸腔积液 2例 ,胆汁漏 1例 ,1例在术后 3月死于肝功能衰竭。④结论 主肝静脉受累的肝脏肿瘤切除虽具有较大风险 ,但只要方法适宜手术仍然是安全和可行的。

Objective\ To investigate the possibility of resection of liver tumors adjacent to the root of hepatic veins. Methods\ Thirty five patients who had undergone hepatectomy for tumors close to the root of hepatic veins in recent three years were analyzed, including 22 cases of hepatocellular carcinoma, 11 cases of haemangioma, one case of FNH and one metastatic carcinoma from lung.\ Results\ The resection of the left liver together with segment Ⅷ were performed in 10 cases, the left liver in two cases, segments Ⅶ and Ⅷ in 10 cases, segments Ⅷ, Ⅴ and Ⅳ in eight cases and segment Ⅷ or part of it in five cases. The middle hepatic vein was ligated or resected in nine cases, and end to end anastomosis was done in one case, the right hepatic vein was ligated in one case, and resected in one case.\ Conclusion\ The resection for liver tumors close to the root of hepatic vein is safe and feasible with appropriate methods, in spite of the high risk.