肝肿瘤专题研究(Monographic Study of Hepatic Tumors)

解剖性右肝三段切除治疗右肝巨大或多发性肝癌

Published at: 2015年第24卷第7期

贾长库 1 , 王石坚 1 , 陈有科 1 , 翁杰 1 , 黄小龙 1 , 符誉 1 , 韩霖 1 , 呼增吉 1
1 海南医学院附属医院 肝胆胰外科,海南 海口 570102
通讯作者 长库 贾 Email: jiachk@126.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.07.005
基金:
海南省应用技术研发与示范推广专项基金资助项目 ZDXM2014074

摘要

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 mL。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。


Anatomic right trisegmentectomy for huge or multifocal right hepatic hepatocellular carcinoma

Abstract

Objective: To investigate the efficacy of anatomic right trisegmentectomy for huge or multifocal right hepatic hepatocellular carcinoma (HCC). Methods: Twelve patients with huge or multifocal right hepatic HCC tumors underwent anatomic right trisegmentectomy with preservation of segment V or VIII, in whom the preoperative CT-based liver volumetry suggested that the percentage of future liver remnant volume (%FLRV) would be insufficient for them after right hemihepatectomy, which could be increased by an average of 14.3% by right trisegmentectomy instead. During operation, the segment V or VIII was identified by use of selective hepatic inflow occlusion, and then a “ ┏┛ ” or “ ┕┓ ”shaped resection line was marked on the diaphragmatic surface of the liver; right hemihepatic or total hepatic inflow occlusion was used according to different resection plane to avoid ischemia/reperfusion injury during parenchymal transection. Results: Anatomic right trisegmentectomy was successfully completed in all patients, with an average operative time of 285 min and intraoperative blood loss of 720 mL. The tumors in all patients were completely resected, the inflow and outflow of segment V or VIII remained intact, no perioperative death occurred, and AFP level in all patients returned to normal range within 2 months after operation. Of the whole group of 12 patients, 10 cases were alive so far with a longest tumor-free survival for 3 years in one case; one case died of obstructive suppurative cholangitis, and one case died of multiple intrahepatic metastases and liver failure, while one case with left hepatic recurrence and 2 cases with lung metastases lived with tumor under comprehensive therapy, but in the remaining cases, no tumor recurrence or metastasis occurred, and liver function parameters and AFP level were in normal ranges. Conclusion: Anatomic right trisegmentectomy guarantees the maximum preservation of remnant functional liver tissue, so it can be a conventional operation for patients with huge or multifocal right hepatic HCC without segment V or VIII involvement, and thereby improves the overall resection rate of HCC.


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引用

引用本文: 长库 贾, 石坚 王, 有科 陈, 杰 翁, 小龙 黄, 誉 符, 霖 韩, 增吉 呼. 解剖性右肝三段切除治疗右肝巨大或多发性肝癌[J]. 中国普通外科杂志, 2015, 24(7): 939-944.
Cite this article as: JIA Changku, WANG Shijian, CHEN Youke, WENG Jie, HUANG Xiaolong, FU Yu, HAN Lin, HU Zengji . Anatomic right trisegmentectomy for huge or multifocal right hepatic hepatocellular carcinoma[J]. Chin J Gen Surg, 2015, 24(7): 939-944.