中央区肝癌肝切除的手术体会

目的总结中央区原发性肝癌手术治疗的经验,以提高中央区肝癌手术的安全性。方法回顾性分析2004~2007年我院行手术切除的中央区肝癌和非中央区(周边区)肝癌患者的临床资料,比较两组术后生化指标和手术时间、血流阻断时间、住院时间、术中出血量、输血量、术后并发症等,及肝切除手术中Pringle s法、半肝阻断法和改良Pringle s法3种不同入肝血流阻断方法的效果。结果中央区肝癌和周边区肝癌两组病变大小、Child-Pugh评分、吲哚青绿15 min潴留率、术后1周内血清天冬氨酸转氨酶、丙氨酸转氨酶、谷氨酰转肽酶、总胆红素、直接胆红素、白蛋白、前白蛋白、胆碱脂酶、血流阻断时间、输血量和肝切除术后并发症发生率、术中出血量差异均无显著性。中央区组肝癌手术时间、住院时间显著长于周边区组(P<0.05)。保留半肝动脉血流的改良Pringle s法入肝血流阻断操作简单,且可有效控制术中出血,减轻肝脏缺血再灌注损伤。结论对中央区肝癌,只要术前做好充分评估和准备,熟悉解剖,选择合适的血流阻断方法,手术切除是安全可行的。

Resection of centrally located primary liver cancer

Objective To summarize the experience of hepatectomy for patients with centrally located primary liver cancer.Methods The clinical data of patients with centrally and non-centrally located primary liver cancer were retrospectively reviewed.The biochemical indicators,operation duration,hepatic inflow occlusion time,hospital stay,operative blood loss,amount of blood transfusion,complication,and effectiveness of three occlusion methods(semi-hepatic inflow occlusion,Pringle's manoeuvre,and modified Pringle's manoeuvre)were analyzed.Results Tumor diameter,Child-Pugh score,indocyanine green retention rate,aspartate aminotransferase,alanine aminotransferase,glutamyltransferase,total bilirubin,direct bilirubin,albumin,prealbumin,cholinesterase,hepatic inflow occlusion time,blood transfusion,postoperative complications,and operative blood loss were not significantly different between patients with centrally and non-centrally located primary liver cancer.Patients with centrally located liver cancer had significantly longer operation duration and hospital stay than patients with non-centrally located liver cancer(P<0.05).The modified Pringle's manoeuvre of hepatic inflow occlusion had the same effectiveness of the Pringle's manoeuvre and could be performed in a simpler way.Conclusions Hepatectomy is safe and feasible for patients with centrally located primary liver cancer.Appropriate preoperative evaluation and preparation,sufficient knowledge of liver anatomy,and proper selection of hepatic inflow occlusion method are key factors to guarantee the success of the resection.