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目的改良肝切除方法以提高累及下腔静脉肝癌手术切除的安全性与可靠性。方法 1999年10月至2011年6月共行位于Ⅰ、Ⅳa、Ⅴ、Ⅷ段深部肝癌切除51例。23例按常规方法切肝(甲组)阻断入肝或全肝血流,余28例(乙组)选择性阻断入肝血流,沿缺血范围,肝表面缝扎,闭合切除、修补受累下腔静脉壁,无损伤血管钳控制肝上下腔静脉血流,取出肝静脉或腔静脉癌栓的方法控制术中出血。结果术中失血量:甲组为200～1600ml,乙组为150～1500ml(P<0.05)。手术时间:甲组为190～350分钟,平均250分钟,乙组:150～310分钟,平均215分钟,(P<0.05)。术后并发症:甲乙两组分别为19和6例(P<0.05)。结论本文报道的方法适合于累及下腔静脉肝癌的切除,而且比常规切肝术安全可靠。
Objective To improve the method of liver resection in order to improve the safety and reliability of surgical resection involving the inferior vena cava. Methods From October 1999 to June 2011, 51 cases of deep hepatic carcinoma were located in Ⅰ, Ⅳa, Ⅴ and Ⅷ. 23 cases of hepatectomy (group A) blocked hepatic or hepatic blood flow according to the conventional method, and the other 28 cases (group B) selectively blocked the hepatic blood flow, and along the ischemic area, the liver surface was sutured and closed, Repair the affected inferior vena cava wall, without injury vascular clamp control of suprahepatic and inferior vena cava blood flow, remove the hepatic vein or vena cava tumor thrombus control method of intraoperative bleeding. Results Intraoperative blood loss: A group of 200 ~ 1600ml, B group of 150 ~ 1500ml (P <0.05). Surgery time: Group A was 190 ~ 350 minutes, an average of 250 minutes, Group B: 150 ~ 310 minutes, an average of 215 minutes, (P <0.05). Postoperative complications: arm A and arm B were 19 and 6 cases (P <0.05). Conclusion The method reported in this paper is suitable for resection of IVC and is safe and reliable than conventional hepatectomy.