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目的总结手术切除侵犯第二、三肝门肝肿瘤的实施方法及安全性。方法回顾性分析2012年5月至2017年5月期间于笔者所在医院接受肝切除手术的39例侵犯第二、三肝门肝肿瘤患者的临床资料。结果 39例患者中,原发性肝癌29例,肝血管瘤6例,肝局灶性增生2例,结肠癌肝转移2例。行右半肝切除11例,左半肝切除7例,左外叶切除6例,右三叶切除5例,Ⅴ、Ⅷ段切除4例,Ⅶ、Ⅷ段切除4例,局部切除2例。切肝时完全不阻断入肝血流16例,间断阻断肝门部血流21例,全肝血流阻断2例。手术时间150~270 min,平均190 min;术中失血100~2 000 m L,平均680 m L。术后出现胆汁漏2例,出血1例,无围手术期肝功能衰竭死亡病例。31例肝恶性肿瘤患者术后获访26例,随访时间3~40个月,中位数为8个月。随访期间,12例患者死亡,其中9例死于肿瘤复发,3例死于肝功能衰竭。8例良性肝病患者获访5例,随访时间7~18个月,中位数为9个月,随访期间均健康生存。结论侵犯第二、三肝门肝肿瘤手术切除的关键在于术前对有功能残肝体积的准确评估及术中对肝静脉主要属支的正确处理。
Objective To summarize the implementation and safety of surgical resection infringing the second and third liver hepatic tumors. Methods The clinical data of 39 cases of infringing second and third hepatic liver tumors in our hospital from May 2012 to May 2017 were retrospectively analyzed. Results Of the 39 patients, 29 were primary hepatocellular carcinoma, 6 were hepatic hemangiomas, 2 were focal liver hyperplasias and 2 were liver metastases from colon cancer. Right hepatic resection in 11 cases, left hepatectomy in 7 cases, left lateral lobectomy in 6 cases, right trilobectomy in 5 cases, Ⅴ, Ⅷ segment resection in 4 cases, Ⅶ, Ⅷ segment resection in 4 cases, partial resection in 2 cases. In the hepatectomy, there was no interruption of hepatic inflow in 16 cases, intermittent occlusion of hepatic portal blood flow in 21 cases and total hepatic occlusion in 2 cases. The operation time ranged from 150 to 270 minutes, with an average of 190 minutes. The intraoperative blood loss ranged from 100 to 2 000 m L with an average of 680 m L. Postoperative bile leakage in 2 cases, 1 case of bleeding, no perioperative liver failure death cases. Thirty-one patients with malignant tumor of liver were followed up for 26 cases. The follow-up time ranged from 3 to 40 months with a median of 8 months. During follow-up, 12 patients died, of whom 9 died of tumor recurrence and 3 died of liver failure. Eight patients with benign liver disease were interviewed in 5 cases. The follow-up time ranged from 7 to 18 months with a median of 9 months. All patients survived well during follow-up. Conclusions The key to the surgical removal of the second and third liver tumors is the accurate assessment of the volume of the functional residual liver before operation and the correct treatment of the main branches of hepatic veins during operation.