125例肝癌解剖性肝切除的技术总结

目的 总结解剖性肝切除治疗肝癌的技术方法.方法 回顾性分析2005年1月至2006年12月复旦大学附属中山医院经解部性肝切除治疗125例单发肝癌患者的临床资料.肝切除前预先选择性阻断欲切除部分肝脏的出入血流;肝外解剖、结扎门静脉及肝动脉主要分支,然后将缺血肝表面颜色转暗区整块切除.采用血管钳沿电刀标志预切线钳夹、破碎切面肝组织.左右肝管断端应用Prolene线连续缝合;对直径＞10 cm的巨大肿瘤借助肝脏悬吊法行前径路切除;用纱布或通过注入美蓝检查肝断面防止术后胆汁漏的发生.结果 125例单发肝癌患者术中平均出血量为250 ml(100～6000 ml),其中93例不需输血.术后并发症发生率为23%(29/125).术后30 d内无手术死亡.术后经动脉造影检查6%(5/83)的患者有癌残留.结论 解剖性肝切除可增加手术安全性,防止损伤供应剩余肝脏的大血管,提高手术疗效.

Techniques of anatomical liver resection for hepatocellular carcinoma:a report of 125 cases

Objective To summarize the techniques of anatomical liver resection for the treatment of hepatocellular carcinoma(HCC).Methods The clinical data of 125 patients with solitary HCC who underwent anatomical liver resection at the Zhongshan Hospital from January 2005 to December 2006 were retrospectively analysed.The inflow and outflow of hepatic segments to be resected were selectively clamped,then the main branches of portal vein and hepatic artery were ligated,and the ischemic hepatic segments were resected en bloc.Kelly forceps were used to crash and clamp the liver cut surface.The stumps of left and right hepatic ducts were continuously sutured with Prolene sutures.For tumors with the size above 10 cm in diameter,hepatectomy with anterior approach and liver hanging maneuver were adopted.Bile leakage was checked by injecting methylene blue or covering a gauze on the liver cut surface.Results The mean blood loss of all patients was 250 ml(100-6000 ml),and 32 of them needed blood transfusion.The morbidity was 23%(29/125).No patient died within 30 days after the operation,and 6%(5/83)of patients were found with residual tumor by postoperative arteriography.Conclusion Anatomical liver resection may improve the safety of operation,prevent the injury of great vessels and thus improve the efficacy.