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目的:探讨解剖性右肝三段切除治疗右肝巨大或多发性肝癌的疗效。方法:12例右肝巨大或多发性肝癌患者术前CT肝脏体积测定显示,若行右半肝切除则预留肝脏体积百分率(%FLRV)不足,若行右肝三段切除则%FLRV平均增加14.3%,故行保留V段或VIII段的右肝三段切除术。术中通过选择性入肝血流阻断的方法确定出V段或VIII段的位置,从而在肝表面标记出一条“┏┛”或“┕┓”形的切除线;在切割横断肝实质时根据不同的切除平面采取右半肝入肝血流阻断或全肝的入肝血流阻断的方法,减轻肝脏缺血再灌注损伤。结果:全部患者顺利完成解剖性右肝三段切除术,平均手术时间285 min,平均失血量为720 m L。肿瘤均完整切除,术后V段或VIII段的出入肝血流均完整保留,无围手术期死亡,所有患者AFP均于2个月内降至正常范围。术后全组12例患者至今10例仍存活,最长1例患者已无瘤生存3年;1例死于梗阻性化脓性胆管炎,1例死于肝脏多发转移肝功能衰竭,另外1例发现肝左内叶复发、2例发现肺部转移患者经综合治疗带瘤生存,其他患者无肿瘤复发、转移等情况,肝功能和AFP水平均在正常范围内。结论:解剖性右肝三段切除术能最大限度地保留无瘤肝组织,可作为V段或VIII段未受累的右肝巨大或多发性肝癌一种常规手术方法,从而提高肝癌的整体切除率。
Objective: To investigate the therapeutic effect of anatomical right hepatic resection on giant hepatomegaly or multiple hepatocellular carcinoma of the right liver. Methods: The preoperative CT volume of liver in 12 patients with right hepatic giant or multiple liver cancer showed that the percentage of liver volume (% FLRV) was reserved if the right hepatectomy was performed, and the average% FLRV was increased 14.3%, so the line to retain the V segment or VIII of the right hepatic resection. Intraoperative selective hepatic blood flow occlusion method to determine the location of the V or VIII segment, so that the liver surface marked with a “┏┛” or “┕┓” -shaped resection line; cutting Transverse liver parenchyma according to the different resection plane to take the right hepatic portal blood flow blocking or hepatic blood flow in the whole liver block method to reduce liver ischemia-reperfusion injury. Results: All the patients successfully completed anatomical right hepatic resection, the average operation time was 285 min, the average blood loss was 720 m L. All the tumors were completely resected. The blood flow to the portal vein of V segment or VIII segment was completely preserved without perioperative death, and the AFP of all patients dropped to the normal range within 2 months. One patient died of obstructive suppurative cholangitis, one died of multiple liver metastasis and liver failure, and the other one patient survived Found that the left internal lobe of the liver recurrence, 2 patients found lung metastasis by comprehensive treatment of tumor survival, other patients without tumor recurrence, metastasis, liver function and AFP levels were within the normal range. CONCLUSION: Anatomical right hepatectomy can maximize the preservation of tumor-free liver tissue and can be used as a routine surgical method for unresectable right or left hepatic carcinoma of V or VIII, thus improving the overall resection rate of HCC .