巨大肝癌的非规则性肝切除

目的介绍直径10～22cm巨大肝癌非规则性肝切除的手术经验。方法巨大肝癌非规则性肝切除的手术要点,包括右叶肝癌左侧卧位,抬高40°体位,肋缘下Kocher切口,左叶肝癌平卧位,双肋缘下人字型切口,肝门Pringle手法血流阻断20min,放开5min。距肿瘤边缘1～2cm钳夹法快速切除肝癌,缝扎肝创面管道,肝创面对拢缝合。结果无手术死亡率、无术后肝衰、出血等并发症,术后复发率为70.0%,5年生存率为15.5%,3年为82.2%。结论掌握肝脏血运与交通支丰富的特点,非规则性肝切除对肝癌合并肝硬化保留正常肝体积具有重要的临床意义,只要术前准确判断肝脏储备功能,有效控制出血,巨大肝癌非规则性肝切除实用、有效和安全可行。

Irregular hepatectomy of 45 cases of bulky hepatocellular carcinama

Objective Introduce the experience of operation in irregular hepatectomy bulky hepatocellular eareinama （diameter：10 -22 cm）. Methods Some points of hepatectomy operation, including the body and insition, and then hepatec hilum vascular occlusion costs twenty minutes, the patency time is five minutes, the distance about tumor edge is 1 - 2 cm, so hepatectomy is safty, clamp method can cut the liver quickly and hepatic wound closed suture. Results No mortality after the operation, there is no hepatic failure, bleeding complicationg etc. the recurrence rate affter operation is 70.0%and survival rate in 5 years is 15.5% ,in 3 years is 82. 2%. Conclusion master the peculiarity of liver blood motion and traffic blood vessel, irregular hepatectomy to liver cancer when cambined cirrhosis retained normalty liver volume has important significance in clinical so as to judge reserve function of liver aceuratly and cotrol the bleeding effectively. It is practical effective and safe to deal with the bulky liver cancer which irregular hepatectomy.