术中超声引导荷瘤门静脉染色在肝癌手术中的临床应用

目的:探讨术中超声引导下荷瘤门静脉置管染色指导肝癌切除手术的临床价值.方法:对45例肝癌患者随机分为试验组22例,对照组23例,试验组应用术中超声引导穿刺选择性荷瘤门静脉置管染色指导肝切除术,对照组应用术中超声定位行传统肝切除手术,观察试验组染色成功率,比较两组在手术时间、手术出血量和手术合并症方面的差异;同时对全组45例患者的术前、术中超声以及病理结果进行比较观察.结果:试验组染色成功率86.4%(19/22),两组在手术时间、手术出血量和手术合并症方面比较无显著性差异;45例肝癌63个癌肿结节的术中超声诊断率98.4%(62/63)明显高于术前超声的84.1%(53/63)(P＜0.05),对静脉内瘤栓的诊断率94%(16/17)亦明显高于术前超声53%的诊断率(9/17)(P＜0.01).结论:术中超声诊断率高,荷瘤门静脉染色对指导手术方案的制定有着重要的临床价值.

Clinical Study on Intraoperative Ultrosound Guided Segmental Staining by Portal Vein Branch to the tumor for the Hepatectomy of Liver Cancer

Objective: To evaluate the effect of intraoperative ultrosound guided segmental staining by portal vein branch to the tumor for the hepatectomy of liver cancer. Methods: Forty-five patients with hepatocelullar carcinoma (HCC) were divided into the experiment group (22) and the control (23) randomly. Hepatectomy was performed under ultrosound guided segmental staining by selective portal vein branch catherterization in experimental group, and tranditional hepatectomy was performed in control group under same condition. The achievement ratio was observed in experimental group, and the operating time, bleeding volume and the complication were compared between the two groups. The results of ultrasound and of pathology both in preoperation and intraoperation were compared. Results: The achievement ratio of segmental staining was 86.4%(19/22) in experiment group. There was no significant difference between operating time, bleeding volume and complication and the diagnosis rate of 63 tumer nodes (45 cases) under intraoperation ultrosound was significantly higher than that of preoperation ultrosound (98.4% vs 84.1%, P<0.05), so did the diagnosis rate of cancer embolus (94% vs 52%,P<0.01). Conclusion: Intraoperation ultrosound plays an important role in the clinical plan of hepatectomy. Segmental hepatectomy might be performed under intraoperation ultrosound guided segmental staining by portal vein branch accurately.