小儿肝门部肝母细胞瘤的手术策略

目的探讨侵犯肝门血管的小儿肝母细胞瘤的手术策略。方法回顾性分析2006年6月至2010年6月作者收治的68例肝门部肝母细胞瘤患儿的临床资料，均使用微波切割技术，在不阻断肝门血流的状态下精细解剖分离，在发生血管损伤出血时则暂时性阻断肝门血管，如影响显露，则分块切除肿瘤。结果68例患儿均接受术前化疗，其中侵犯第一肝门17例，侵犯第二肝门51例。15例患儿第一肝门阻断时间在5min以内，2例患儿全肝血流阻断时间为5min。术中平均失血量25mL，6例因失血较多予输血治疗。无手术死亡病例。并发胆瘘3例，肝周积液5例，乳糜腹1例。结论对于肝门部肝母细胞瘤，采取术前化疗可降低手术难度，精细解剖是基本措施，分块切除是可选方法，肝门血管阻断无法保障安全，不损伤肝门血管是患儿生命安全的重要保障。

Resection strategy for hilum seated hepatoblastoma in children

Objective To discuss the strategy for resection of hepatoblastoma at hitus area. Methods Retrospective analysis was induced to 68 cases of hilum seated hepatoblastoma admitted from June 2006 to June 2010. In all the cases, microwave dissection was used for refined anatomy and resection with normal blood in- flow. When bleeding, portal triad clamping was used to control blood loss. The tumor tissue covered hilum vascu- lar was peeled after removing the tumor trunk. Results All the 68 cases underwent preoperative chemotherapy. The portal fissure were involved in 17 cases and hepatic vein invaded in 51 cases. In 15 cases, the portal triad clamping were less than 5 minutes. In 2 cases, total vascular exclusion was induced less than 5 minutes. The average blood loss in operation was 25 mL. Only 6 cases accepted blood transfusion for blood loss. There was no intraoperative mortality. After surgery, bile leakage occurred in 3 cases, parahepatic fluidifying in 5 cases, and ckyloperitonium in one case. Conclusion Preoperative chemotherapy made surgery somewhat easy. Refined anatomy and resection was basic skill. Peeling Removal at critical area was recommended. Inflow blood control could not protect operation safe. The key for safety was not to injure the hilum vascular.