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目的探讨肝三叶切除治疗巨大肝肿瘤的安全性和可行性。方法对21例平均直径15.7(12～36)cm的巨大肝肿瘤,其中包括原发性肝癌15例,肝平滑肌肉瘤1例,肝海绵状血管瘤5例,在入肝血流阻断下行肝肿瘤切除。结果21例肿瘤均得以顺利切除,行肝右三叶切除术14例,肝左三叶切除术7例。切除肿瘤重量平均2010(1230～6725)g,平均出血量980(150～4000)ml,入肝血流平均阻断时间23(12～63)min,其中入肝血流阻断1次者16例(76.2%),2次者5例(23.8%)。术后所有病人均出现一过性肝功能损害,1例(4.8%)发生肝功能衰竭于术后19d死亡,13例(61.9%)有一过性腹水,7例(33.3%)右侧胸腔积液,均经进一步处理后恢复顺利。20例获随访,14例原发性肝癌患者1、2、3、5年生存率分别为57.1%、35.7%、28.6%和7.1%,1例肝平滑肌肉瘤患者术后生存29个月,死于肿瘤复发及广泛转移,5例肝血管瘤患者术后均健康生存。结论肝三叶切除术难度大,但只要术前正确评估,术中方法得当,肝脏储备功能良好,围手术期处理适宜,仍是安全可行的。
Objective To investigate the safety and feasibility of hepatic trilobectomy for the treatment of giant liver tumors. Methods Twenty-one cases of giant liver tumors with an average diameter of 15.7 (12-36 cm), including 15 cases of primary liver cancer, 1 case of hepatic leiomyosarcoma and 5 cases of hepatic cavernous hemangioma. Tumor resection. Results Twenty-one cases of tumors were successfully resected. There were 14 cases of right hepatic trilobectomy and 7 cases of left hepatic trigeminal excision. The average weight of tumor was removed in 2010 (1230 ~ 6725) g and average bleeding volume was 980 (150 ~ 4000) ml. The mean interruption time of hepatic blood flow was 23 (12 ~ 63) min. Cases (76.2%), 2 times in 5 cases (23.8%). One patient (4.8%) had liver failure and died at 19 days after operation. Thirteen patients (61.9%) had transient ascites and seven patients (33.3%) had right pleural effusion Liquid, after further treatment recovered smoothly. Twenty patients were followed up. The 1, 2, 3, 5-year survival rates of 14 patients with primary liver cancer were 57.1%, 35.7%, 28.6% and 7.1% respectively. One patient with leiomyosarcoma of the liver survived for 29 months and died In tumor recurrence and extensive metastasis, 5 cases of hepatic hemangioma patients survived after operation. Conclusions Hepatic trefoil resection is difficult, but it is safe and practicable to properly evaluate the operation, correct intraoperative methods, good liver reserve and proper perioperative management.