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楔形或非解剖性肝切除术企图多保存有功能的肝组织,常难获得清净的切缘,并可能发生深部组织出血.作者报道13例16个肿瘤使用冷冻辅助肝切除术的经验,有控制地切除肿瘤,可取得良好的无瘤切缘.方法 术前静脉注入单一剂量预防性抗菌素.作双侧肋下切口进腹游离肝脏.经双合诊和术中超声波定位后,根据肿瘤大小,在超声波指引下将一种5或10mm直径的液氮真空绝缘探针插到肿瘤中央.置入纱布垫保护周围脏器.冷冻时先阻断血流,用超声波监视冷冻情况,可见到高回声区及其后自病灶中央缓慢扩展的声影、冷冻可达距肿瘤周缘外1cm.平均冷冻时间8分钟.暂时恢复肝血流2分钟后作切除术时再阻断之.为维持“水球”恒定大小,可每过一分钟再冷冻一分钟.如此既能预防“水球”扩大,又可在切除时用此探针作为“把柄”牵动使“水珠”与肝实质之间暴露良好,见到血管可结扎止血.若超声波显示肿瘤靠近主要静脉(如右肝静脉),则需自下腔静脉处搬动肝脏并游离阻断右肝静脉,使手术安全进行.氩气刀对创面沏底止血很有价值.若对切缘有疑问可用一种扁平探条进一步冷冻.
Wedge-shaped or non-anatomical hepatectomy attempts to preserve more functional liver tissue, often with difficult margins, and deep tissue bleeding. The authors report 13 cases of 16 tumors using cryoassisted hepatectomy with controlled experience. To remove the tumor, a good margin without tumor can be obtained. Preoperative intravenous injection of a single dose of prophylactic antibiotics. Bilateral subcostal incision into the abdomen free liver. After double diagnosis and intraoperative ultrasonic positioning, according to the size of the tumor, Under ultrasound guidance, a 5- or 10-mm-diameter liquid nitrogen vacuum insulated probe is inserted into the center of the tumor. A gauze pad is placed to protect the surrounding organs. The blood flow is blocked when frozen, and the frozen condition is monitored with ultrasound. High echo can be seen. In the area and afterwards, the slowly expanding acoustic shadow from the center of the lesion, the frozen reachable 1 cm from the periphery of the tumor, the average freezing time of 8 minutes, and the temporary resumption of liver blood flow for 2 minutes after resection for resection. To maintain the “water balloon” Constant size, can be frozen for one minute every minute. This can prevent the expansion of the “water balloon”, but also use this probe as a “handle” in the resection so that the “water droplets” and liver parenchyma exposed well, see To the blood vessels Ligation and hemostasis. If the ultrasound shows that the tumor is close to the main vein (such as the right hepatic vein), it is necessary to move the liver from the inferior vena cava and free to block the right hepatic vein, so that the operation is safe. Argon gas knife to stop the bleeding at the end of the wound is very Value. If there is doubt about the margin, use a flat boulder to further freeze.