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目的探讨逆行肝切除术在巨大肝癌切除术中的应用价值。方法 2008年7月至2010年6月河南省肿瘤医院肝胆外科共收治肝癌1 246例,其中巨大肝癌采用逆行肝切除术27例。与常规肝切除术相反,首先离断肝脏,然后分离病侧肝脏周围韧带,去除肿瘤。如周围脏器被肿瘤侵犯或有紧密粘连难以分离,则将受累部分器官连同肿瘤一病切除。结果本组27例全部成功切除肿瘤,平均手术时间2.2h(1.3～4.3h),平均离断肝脏时间约26min(18～42min),平均术中出血340 ml(210～1300 ml),平均输血260 ml。本组无围手术期死亡病例,消化道出血1例,肝断面积液2例,右侧胸腔积液5例,膈下感染1例。结论对于术野显露困难、与周围脏器紧密粘连或有侵犯的巨大肝癌,逆行肝切除术是一种安全、有效的手术方法。
Objective To investigate the value of retrograde hepatectomy in the resection of giant hepatocellular carcinoma. Methods From July 2008 to June 2010, 1 246 cases of hepatocellular carcinoma were treated in Hepatobiliary Surgery of Cancer Hospital of Henan Province, including 27 cases of giant liver cancer treated by retrograde hepatectomy. Contrary to conventional hepatectomy, the liver is first severed and the ligaments around the diseased liver are isolated to remove the tumor. If the surrounding organs by the tumor invasion or close adhesion difficult to separate, then part of the affected organs along with the tumor removed. Results All the 27 cases were successfully resected. The average operation time was 2.2h (1.3 ~ 4.3h). The mean time to the interruption of the liver was about 26min (18 ~ 42min). The mean intraoperative blood loss was 340ml (210 ~ 1300ml) 260 ml. This group of patients without perioperative deaths, gastrointestinal bleeding in 1 case, liver cross-sectional area in 2 cases, 5 cases of right pleural effusion, subcutaneous infection in 1 case. Conclusions Retrograde hepatectomy is a safe and effective surgical method for giant hepatocellular carcinoma which is difficult to reveal in the operative field, closely adhered to the surrounding organs or has invaded.