非规则肝切除治疗原发性肝癌

目的 探讨原发性肝癌行非规则切除的处理方法。方法 在近8年中对103例肝癌行非规则肝切除,术式包括联合肝段切除、部分肝段切除、联合右前后叶部分切除、左内叶楔形切除及左右半肝切除、左三叶肝切除等。对中央型(Ⅳ、Ⅴ、Ⅶ段)肝切除,由于其于第一、二肝的关系密切,紧贴或累及大血管,切除时应预置血管阻断带。Ⅶ段切除时应注意至少保留肝中或肝右静脉一支,以利肝静脉回流。肝断面处理提倡尽可能对拢缝合。结果 无手术中死亡。91例痊愈,3例因肝硬变严重术后15 d内死于肝衰,8例有不同程度胸腹水和肺部感染。随访82例,1、3、5年生存率为62.2％、25.6％和12.2％。结论 非规则肝切除毋需解剖肝门,手术步骤简化,便于普及且对合并肝硬变者可以减少切肝量,利于防止肝衰、减少并发症。

Non-regular hepatectomy to therapy primary liver cancer

Objective To study the operative methods of non-regular resection to therapy primary liver can-cer. Methods 103 patients have nudergone non-regular resection during the last 8 years in our hospital. Operative methods including:combined hepatic segments resection,part hepatic segments resection,combined pan right priority and posterior lobectomy of live,left interior lobectomy of liver,left and right lobectomy and left three lobectomy and so on. Vascular blocking belt should be used preventively when IV , V ,VI segments section were carried out,for it is near the first and second hepatic portal and cling or infiltrate greater vascular. When I segment resection were car-ried out at least a branch of central veins of liver or right hepatic veins should be reserved to ensure hepatic veins back flow unobstruction. Hepatic cross section should take pains to suture. Results There were no patients died intraoper-ation 91 cases were cured.3 cases died of hepatic failure 15 days after operation for serious hepatocirrhosis,8 cases had hydrothorax and ascites of different degree.82 cases were folio wed-up, survival rate of K3 and 5 years were 62. 2% ,25.6% and 12.2% respectively. Conclusion Non-regular liver resection need not dissect hepatic portal, the operative methods briefs and easy to dissmination. For patients with hepatocirrhosis, the operative methods may de-crease the amount of resected liver, be good to prevent liver failure and decrease complications.