肝脏微小占位病变的手术定位与切除

目的 探讨肝脏2cm以下实质性微小占位的手术定位及切除。方法 1986－2000年经影像学检查发现、病理确诊的直径≤2cm肝脏实质性小占位病变27例，共34个病灶。结果 术中看见肿瘤侵犯肝包膜6个病灶；术中可扪及13个病灶；均行肝局部切除术。未触及15个病灶分别根据术前影像学定位下行肿瘤局部切除4个，肝段或半肝切除5个；术中B超定位下切除4个；手术原疤痕定位肿瘤局部切除2个。结论 熟悉肝脏的解剖及多种影像学检查是肿瘤定位的基础。术中的全肝扪诊，可避免病灶的遗漏；对不能触及的小病灶，可根据术前影像学定位下切除或行术中B超检查或肝包膜切开探查，切除病灶。

Localization and resection of liver minute nodule

Objective To study the localization and resection of minute space-occupying lesions in the liver with a diameter less than 2 cm. Methods The clinical data of 27 patients with minute space-occupying in the liver treated in our hospital from 1986 to 2000 were retrospectively analyzed. In these 27 patients, a total 34 foci were pathologically confirmed and their maximal diameter was equal to 2 cm. Results Six foci were found to have invaded the liver capsule. Thirteen foci that could be touched were treated with limited resection. As for the other 15 foci that could not be touched, 4 were treated with limited resection and 5 with segmentectomy or lobectomy of the liver based on preoperative localization by imaging technique, 4 received resection according to the localization by B-mode ultrasonography during the operation and 2 limited resection because of quandom operation scar. Conclusions Knowing the liver anatomy and image characteristics is important for localizing the segment of lesions. Touching the whole liver during operation can avoid missing lesions. Those small lesions that can not be touched can be resected according to preoperative localization by imaging technique, perioperative B-mode ultrasonography or exploration through incising the liver capsule.