原发性肝癌术后胸腔积液的预防和治疗

目的探讨原发性肝癌术后胸腔积液的原因并总结防治经验。方法回顾性分析我院2000年7月至2004年6月各类右肝切除手术523例患者的临床资料。结果523例行肝切除术的患者,术中采用氩气电刀游离肝脏,术后出现胸腔积液20例,发生率为3.8%;同期行右肝切除的467例患者,术中采用常规方法游离肝脏且肝切除后常规对拢缝扎膈肌创面,术后出现胸腔积液49例,发生率10.5%,两者比较差异非常显著(P<0.01)。术后膈下积液、术后肝功能不全伴中等量以上腹水、肝门阻断时间长、肝硬化等是肝癌肝切除术后胸腔积液发生的重要原因。结论采用氩气电刀游离肝脏且不常规对拢缝扎膈下创面能较好地预防术后胸腔积液的发生;伴有临床症状的中等量以上的胸腔积液采用中心静脉导管置管引流效果良好,值得临床推广应用。

PREVENTION AND TREATMENT OF POST-OPERATIVE PLEURAL EFFUSION FOR PATIENTS WITH PRIMARY LIVER CANCER

Objective To investigate the cause ,prevention and treatment of post-operative pleural effusion in patients with primary liver cancer.Method Clinical data of 523 primary liver cancer patients underwent different kinds of right hepatectomy from Jul, 2000 to Jun, 2004 were analyzed retrospectively.Results We dissociated the liver by argon beam coagulation in all 523 patients during the operation, and among them, there were 20 patients (3.8%) had pleural effusion post-operatively. At the same period, there were another 467 primary liver cancer patients underwent hepatectomy, we accepted the conventional methods to dissociate the liver, sutured and ligated the wound of diaphragm, and among them, there were 49 patients(10.5%) had pleural effusion after operation, the difference of the morbidity of post-operative pleural effusion between the two groups was significant (P<0.01). The important causes of the complication of post-operative pleural effusion are subphrenic hydrocele, post-operative liver dysfunction accompanied with medium ascites or more, long time of block of the first porta hepatis and liver cirrhosis.Conclusion Dissociation of the liver by argon beam coagulation without suture and ligation of the sub-phrenic wound can decrease the morbidity of post-operative pleural effusion in primary liver cancer patients underwent hepatectomy, in patients accompanied with clinical symptom who have medium amount of pleural effusion or more, we place a central venous catheter in the thorax for drainage and it works well.