选择性血流阻断配合超声乳化吸引刀切除中央型肝肿瘤

目的 探讨选择性血流阻断配合超声乳化吸引刀切除中央型肝肿瘤的效果.方法 选择性阻断肿瘤所在肝叶的进出血流,超声乳化吸引刀解剖,行中央区肝段切除.结果 自2006年7月至2008年1月,采用这种外科技术治疗中央型肝肿瘤46例.本组患者术前肝功能Child A级43例,Child B级3例.39例患者一次性肝区域性全血流阻断8～33 min.术中出血量100～2400ml,平均490ml.43例术后在一周内肝功能恢复至A级;3例术后出现腹水,其中1例并发黄疸;2例发生胆瘘;1例胃瘫,1例术后第3天并发大面积心梗死亡.35例恶性肿瘤患者中位随访9个月,1例患者术后10个月因肿瘤腹腔及肝内转移死亡,34例患者至今无瘤生存.结论 肝区域性进出血流阻断能有效控制切肝时的出血;应用超声乳化吸引刀切肝,解剖清晰,综合应用这两种技术,能较安全地切除肝脏任何部位的肿瘤.

Central hepatectomy using hepatic blood flow exclusion and CUSA

Objective To improve the resection rate of central type hepatoma. Method Under selective exclusion of hepatic blood flow and the use of caritational ultrasonic surgical aspiration (CUSA), hepatectomy of central hepatic segments was performed for liver tumors. Result There were 46 cases in this group. Preoperative hepatic function was Child A in 43 cases and Child B in 3 cases. Regional entire bloodstream was excluded ranging from 8 to 33 minutes in 39 cases, Intraoperative blood loss was 100 to 2400 ml,the average was 490 ml. Postoperative hepatic function recovery to Child A grade in 43 cases within one week, postoperative aacites developed in 3 cases, jaundice in 1 case, biliary fistula in 1 case, gastroplegia in 1 case. One patient died of myocardial infarction 3 days postoperatively. Thirty-five malignant cases were followed-up with a mean period of 9 months, one died of intraabdominal metastasis 10 months postoperatively, the other 34 cases was alive without recurrence. Conclusion Hepatic regional entire bloodstream exclusion is effective in the control of intraoperative blood loss ; Hypersound-emulsifying- attractor separates blood vessels and bile ducts in hepatic hilar region. The combination of these two techniques helps in the resection of central hepatic tumors.