Ⅲ、Ⅵ期小儿肝母细胞瘤术中肝内血管的处理

目的 探讨小儿肝母细胞瘤累及肝内重要血管术中处理方法及其疗效.方法 对2005年4月至2008年8月25例小儿肝母细胞瘤切除术中对累及肝内重要血管的具体处理方法进行分析,按术中受累血管处理不同分为2组,血管结扎组10例、血管修补组15例,血管结扎组:累及的肝内重要血管连同瘤体、受累肝叶/肝实质一并结扎切除;血管修补组:对受累肝内重要血管分离,尽可能保留受累肝内重要血管及所支配之正常肝叶/实质.结合术后随访情况分析疗效.结果 血管结扎组中放弃手术1例,姑息性切除3例,完整切除6例,术后肝功能衰竭死亡2例,痊愈出院4例;血管修补组均完整切除痊愈出院.随访5～36个月(中位随访时间20个月),血管结扎组生存1例,血管修补组生存11例.结论 辅以血管修补的肿块切除术可扩大肝母细胞瘤手术适应证,有效预防术后肝功能衰竭,安全度过围手术期,为早期化疗提供时机.

Surgical management of intrahepatic vessel of infantile hepatoblastoma

Objective To evaluate the treatment of the intrahepatic vein involved in hepatectomy of hepatoblastoma.Methods The detail management of the intrahepatic pivotal vein in hepatectomy of 15 hepatoblastomas was recorded.The patients were divided into 2 groups (10 in vessel ligation group,15 in vessel repair group),and the outcomes were analyzed.Results Of the vessel ligation group,one operation was abandoned,there were 3 palliative excisions,6 complete tumor resection,two perioperative death secondary to liver failure,four patients were discharged;All patients in the vessel repair group had complete tumor resection and were discharged.The follow-up duration ranged from 5 to 36 months (median=18 months).There was one tumor free survival in the vessel ligation group,and 11 in repair group.Conclusions The hepatectomy with vessel repair minimizes postoperative liver failure.