逆行肝切除在巨大肝癌切除术中的应用

目的探讨逆行肝切除术在巨大肝癌切除术中的应用价值。方法 2008年7月至2010年6月河南省肿瘤医院肝胆外科共收治肝癌1 246例,其中巨大肝癌采用逆行肝切除术27例。与常规肝切除术相反,首先离断肝脏,然后分离病侧肝脏周围韧带,去除肿瘤。如周围脏器被肿瘤侵犯或有紧密粘连难以分离,则将受累部分器官连同肿瘤一病切除。结果本组27例全部成功切除肿瘤,平均手术时间2.2h（1.3～4.3h）,平均离断肝脏时间约26min（18～42min）,平均术中出血340 ml（210～1300 ml）,平均输血260 ml。本组无围手术期死亡病例,消化道出血1例,肝断面积液2例,右侧胸腔积液5例,膈下感染1例。结论对于术野显露困难、与周围脏器紧密粘连或有侵犯的巨大肝癌,逆行肝切除术是一种安全、有效的手术方法。

Retrograde Hepatectomy in Huge Hepatocellular Carcinoma

Objective To investigate the value of applying retrograde hepatectomy in huge hepatocellular carcinoma.Methods Totally 1246 patients with hepatocellular carcinoma were admitted in Henan tumor hostpital from July 2008 to June 2010,27 of them with hepatocellular carcinoma received retrograde hepatectomy.Contrary to the conventional liver resection,the method of retrograde hepatectomy needs resecting the liver first and then separating the surrounding ligaments to remove the tumor.If adjacent organs are encroached or conglutinate to the tumor,we resect both the organs and the tumor.Results The tumor were successfully removed in all the 27 cases with an average operation time of 2.2h（1.3～4.3h）,an average liver-resecting time of 26min（18～42min）,an average intraoperatie bleeding of 340 ml（210～1300 ml） and an average blood transfusion of 260 ml.No patient dies during the operation period with only one case of gastrointestinal bleeding,two cases of liver section effusion,five cases of right pleural effusion and one case of diaphragm infection.Conclusion Retrograde hepatectomy is a secure and effective operation method to be applied in huge hepatocellular carcinoma which conglutinate to or encroach adjacent organs.