中肝切除术在肝脏中部肿瘤的应用

摘要

目的 探讨中肝切除术在肝脏中部肿瘤的临床应用,对其适应证、治疗效果,特别是外科手术技术细节进行讨论.方法 回顾2007年12月至2009年3月的3例中肝切除术.分析各病例影像学特点,讨论适应证具体标准,总结手术技术细节、手术后恢复过程及随访结果.结果 3例中肝切除术,原发性肝癌合并肝硬化2例,肝脏巨大血管瘤1例.病变部位为Ⅳ段和(或)Ⅷ段.术中平均出血量为800 ml.平均手术时间为7 h.术后7 d左右肝功能基本恢复.术后7～9 d出院.无术后并发症.术后随访7～15个月,无肿瘤复发.结论 中肝切除术是肝脏中部肿瘤的重要手术方式.遵循解剖性肝切除的概念,灵活应用肝切除新的技术手段,可以保证手术的安全性,并减少出血等并发症.对于肝脏储备功能受损者,与扩大的左或右肝切除术比较,中肝切除术具有更高的安全性.应该适当扩大中肝切除的临床应用并对其进行更多的研究评价,特别是与传统的扩大肝切除术相比.%Objective To summarize the initial experience in application of mesohepatectomy for the treatment of central liver tumors while focusing on its indication, short-term and long-term prognosis and especially outlining its technical details. Methods The clinical data of 3 patients receiving mesohepatectomy from December 2007 to March 2009 in our hospital were retrospectively analyzed.The imaging characteristics were summarized to convey the indication details. The technique details of the operation were outlined so as to reduce blood loss or other complications during and after the operation. The post-operative course and follow-up data were also collected and analyzed. Results Two patients suffered from primary hepatocellular carcinoma with liver cirrhosis and the other from giant hemangioma. The tumors were located in Couinaud yegment Ⅳ and/or Ⅷ. The average blood loss and operative duration were 800 ml and 7 h, respectively. Blood liver function tests returned to normal within 7 days postoperatively and the patients were discharged after that. No complications occurred. The follow-up for 7-15 months showed that there was no recurrence. Conclusion Mesohepatectomy is the principal choice of treatment for centrally located liver tumors. For the safety and avoidance of complications, the doctor should abide by the concept of segment-oriented hepatectomy and apply the updated techniques such as CUSA (Cavitron ultrasonic surgical aspirator). For patients with compromised liver function, mesohepatectomy might be superior to extended bepatectomy. Thus, the application of mesohepatectomy should be expanded. Meanwhile, further investigation is needed for its full evaluation.