大肝癌外科治疗时肝血流阻断的合理应用

目的 探讨较大肝癌病人外科治疗时肝血流阻断方法的合理应用及累及下腔静脉肝癌切除的可行性。方法 观察分析我科近3年47例大肝癌病人行肝切除时入肝血流阻断的不同方式对手术能否切除的影响及病人术后恢复的情况。结果 47例病人中行常规肝门阻断27例，选择性半肝血流阻断16例，综合性肝门阻断4例，全部病人手术治疗都成功切除肿瘤，手术顺利，术后无严重并发症，术后恢复良好。结论 对大肝癌病人，术前根据影像学检查资料及肝功能等级，术中熟练的切肝技术等综合因素，合理选用一种肝血流阻断法是保证手术成功，术后病人顺利恢复，提高中晚期肝癌人群疗效的关键。

Rational application of hepatic vascular exclusion for resection of large liver carcinoma

Objective To investigate the rational methods of hepatic vascular exclusion for resection of large liver carcinoma and resectability of liver carcinoma involving inferior vena cava (IVC). Methods In the past 3 years, liver carcinoma resection was performed for 47 patients in our hospital using 3 different manners of hepatic vascular exclusion. The operational course, the duration and type of hepatic vascular exclusion and the variation of postoperative liver function were evaluated. Results Of the 47 patients, 27 received the routine Pringl's maneuver, 16 selective hemihepatic vascular exclusion and 4 comprehensive sequential hepatic vascular exclusion. All tumors were entirely removed and all the patients recovered evenly without operative death and severe postoperative complications. Conclusions The rational methods of hepatic vascular exclusion during hepatectomy of large liver carcinoma should be decided according to preoperative liver function tests and the results of images (CT or/and MRI) in combination with the actual location of the tumor and skillful hepatectomy during surgical exploration. It is still worthwhile adopting an aggressive operative approach to this group of patients.