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根据Nakamara的尸解资料,右肝的静脉回流血管以右肝主静脉单独存在占32%～36%;伴有右肝下静脉占31%～37%;同时伴有右肝中静脉及右肝下静脉占20%～24.1%.作者为一巨大肝细胞性肝癌伴有多发肝内转移患者实行了切除右肝主静脉,保留右肝中、下静脉的扩大左肝三叶切除术.由于切除了回流右肝的主要静脉,因而与传统的左肝三叶切除不同.病例:72岁男性患者.入院时检查,由维生素K桔抗剂Ⅱ诱导的蛋白水平稍高,为2.4单位.但15分钟靛氰绿潴留率正常.腹部B型超声检查发现左肝巨大镶嵌形肿物14.9×12.7cm,并伸展到右肝前叶.近右肝主静脉的右肝S7段可见一8mm肝内转移灶.右肝后段可见较细小的右肝中静脉及下静脉.增强CT扫描及血管造影证实了巨大左肝肿瘤的存在.下腔静脉造影可以显示细小右肝中静脉及下静脉.手术中还发现肝尾状叶亦有转移结节.因而决定实行扩大左肝三叶切除.肝切除范围还包括右肝后上段(S’)及肝尾状叶.同时结扎及切除右肝主静脉,右肝中静脉及下静脉仔细保留未受损伤.
According to Nakamara’s autopsy data, the right hepatic venous return artery was present in 32% to 36% of the right main hepatic vein alone; with the right subhepatic vein accounting for 31% to 37%; accompanied by a right middle hepatic vein and a right liver. The lower vein accounts for 20% to 24.1%. The authors performed a resection of the right main hepatic vein in patients with a large hepatocellular carcinoma with multiple intrahepatic metastases, and retained an enlarged left hepatic trilobectomy in the right and middle hepatic veins. The main vein of the right hepatic artery was regurgitated, and thus was different from the conventional left hepatic trilobectomy. Case: 72-year-old male patient. On admission, the level of protein induced by vitamin K antibiotic II was slightly higher at 2.4 units. Minute cyanide green retention rate was normal. Abdominal B-mode ultrasonography revealed a large mosaic of left hepatic masses of 14.9 x 12.7 cm, and stretched to the right anterior lobe. An 8 mm intrahepatic metastasis was seen in the right hepatic segment of the right hepatic vein of S7. Foci. The right middle hepatic vein and inferior vein are visible in the right segment of the right liver. Enhanced CT scans and angiography confirm the existence of a large left liver tumor. The inferior vena cava angiography can show a small right middle hepatic vein and a lower vein. It was also found that the hepatic caudate lobe also had metastatic nodules. Therefore, it was decided to expand the left liver. Lobectomy liver resection rear right hepatic further includes an upper section (S ’) and liver caudate while ligation and resection of primary hepatic vein, hepatic vein and the vein carefully retained intact.