论文部分内容阅读
目的评估肝蒂联合右肝静脉阻断在巨块型肝癌切除中的作用和意义。方法对2003年2月至2006年8月中南大学湘雅二医院肝胆外科收治的138例位于右半肝及中央型的巨大肝癌行肝蒂联合右肝静脉阻断,观察肝脏血流阻断时间、手术时间、术中出血量、术后肝功能的变化及术后并发症。结果135例在肝外游离出右肝静脉并加以阻断,3例以小的心耳钳沿腔静脉方向纵行夹住右肝静脉阻断出肝血流。所有病例右侧均顺利阻断肝蒂。肝脏血流阻断时间平均为(18±6)min,手术时间平均为(180±45)min,术中出血400~1200mL,56例术中未输血。术后无一例发生肝功能衰竭。术后膈下感染2例,胆漏4例,经引流自愈。结论在巨块型肝癌切除中,肝蒂联合右肝静脉阻断技术可以有效地减少术中出血,降低术后肝功能衰竭的发生率。
Objective To evaluate the role and significance of the combination of hepatic pedicle and right hepatic vein occlusion in the resection of massive liver cancer. Methods Between February 2003 and August 2006, 138 cases of giant hepatocellular carcinoma located in the right hepatic and central hepatocellular carcinoma admitted to Department of Hepatobiliary Surgery, Second Xiangya Hospital of Central South University were treated with hepatic pedicle and right hepatic vein occlusion. The time of hepatic blood flow occlusion , Operation time, intraoperative blood loss, postoperative liver function changes and postoperative complications. Results Of the 135 cases, the right hepatic vein was isolated and blocked in the extrahepatic region. In 3 cases, the small hepatic artery was used to clamp the right hepatic vein longitudinally along the direction of the vena cava and occlude the hepatic blood flow. The right side of all cases were successfully blocked the pedicle. The average time of hepatic blood flow occlusion was (18 ± 6) min, the average operation time was (180 ± 45) min, the intraoperative blood loss was 400 ~ 1200 mL, and 56 patients were without blood transfusion. No case of postoperative liver failure. Postoperative subphrenic infection in 2 cases, 4 cases of bile leakage, self-healing after drainage. Conclusion In the massive resection of liver cancer, combined with the right hepatic vein occlusion technique can effectively reduce intraoperative bleeding and reduce the incidence of postoperative liver failure.