摘要
目的 探讨无血切肝术在治疗常规手术方法难以切除的肝脏原发性恶性肿瘤中的价值。方法 选择有肝切除手术适应证而以常规手术方法不能切除 ,或外院已作剖腹手术未能切除的肝脏原发性恶性肿瘤 ,加施无血切肝技术进行治疗 6 8例资料进行总结分析。结果 6 8例均完成无血切肝术 ,其中经腹常温下全肝血流阻断切肝术 6 6例 ,经胸腹联合切口常温下全肝血流阻断切肝术 +右肺下段转移癌切除术 2例。施行右三叶肝切除 3例 ,左三叶肝切除术 2例 ,右半肝切除 13例 ,左半肝切除术 12例 ,肝中叶切除术 6例 ,肝尾叶切除术 5例 ,联合肝段切除术 2 8例。附加下腔静脉壁部分切除 ,修补术 12例 ,门静脉癌栓摘除术 16例 ,主肝静癌栓摘除术 2例 ,下腔静脉癌栓摘除术 1例。术中阻断全肝血流的时间最长 2 6 min,最短 4分钟 ,平均 12 .2 min± 5 .9min,超过 2 0分钟者仅 2例 ,分别为 2 3min,2 6 min。术中连续监测 HR、SAP、DAR、MAP、CVP及尿量 ,均平稳。术后监测 AL P、L DH、r- GT、BUN、Cr均正常 ,AL T均有不同程度升高 ,护肝治疗 7～ 10天恢复正常。病理诊断 :原发性肝癌 (PL C) 6 1例 ,肝母细胞瘤 5例 (均为小儿 ) ,肝脏血管内皮肉瘤 1例 ,原发性肝脏恶性淋巴瘤 1例。全组顺利康复 6 6例 ,死亡 2例 ,手术死亡率 2 .9%。
Objective To evaluate clinical significance of liver resection for primary hepatic maligance with THVE.Methods A retrospective analysis was made on 68 primary hepatic malignancy using THVE admitted from Oct,1989 to Oct,1999.These patients who can not be treated by the conventional hepatectomy were selected to be treated by THVE.Result THVE was tolerated in all patients.The procedures were performed in 5 extended lobectomies(3 right,2 left),13 right lobectomies,12 left lobectomies and 38 segmentectomy(include bisegmentectomy).The mean clamp times were 12.2±5.9 minutes,97% had clamp times of <20 minutes.ALT was sharpest increase on postoperative and was returning to normal by the time of discharge.There were 2 perioperative death with mortality rate of 2.9%.Conclusion THVE method greatly improved the resectablity and safety for primary hepatic maligancy when liver resection cannot be performed by the conventional liver resection method.THVE has been adopted as a safe and useful technique.
出处
《肝胆外科杂志》
2000年第3期178-179,共2页
Journal of Hepatobiliary Surgery
关键词
肝血流阻断
肝切除术
肝肿瘤
治疗学
Total hepatic vascular exclusion Hepatectomy Hepatom Treatment
