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

绕肝提拉法在联合肝脏离断和门静脉切断二步肝切除术中的应用

Published at: 2015年第24卷第1期

王志明 1 , 胡宽 1 , 苌群刚 1 , 黄云 1 , 周乐杜 1 , 李新营 1 , 李劲东 1 , 陶一明 1
1 中南大学湘雅医院 普通外科,湖南 长沙410008
通讯作者 一明 陶 Email: yimingtao@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.01.003
基金:
国家自然科学基金面上项目 81372630,81372631
中南大学湘雅医院2014 年度临床科研基金资助项目 2014L07

摘要

目的:探讨绕肝提拉法(LHM)在联合肝脏离断和门静脉切断二步肝切除术(ALPPS)中的应用效果。 方法:回顾性分析4 例原发性肝细胞癌行ALPPS 术患者临床资料,其中肝右叶肿瘤3 例,肝尾状叶肿 瘤1 例,均采用LHM 法导引的一期左、右肝脏原位劈离,右门静脉切断;二期行肿瘤完整切除。 结果:4 例均预先游离肝脏, 成功安置弹力带, 顺利实施二期肝切除术; 一期手术时间195~273 (232.2±35.3)min,术中失血420~1 210(735±344.3)mL,并发胆瘘1 例;二期手术时间98~186 (139.5±36.6)min,术中失血100~320(197.5±95.3)mL;无手术死亡;术后随访3 个月,3 例情 况良好,1 例术后2 个月复发死亡。 结论:LHM 法对于下腔静脉的保护,充分显露左右肝动脉、肝静脉、肝内胆管有较好的效果,可常规 适用于肝肿瘤ALPPS 二步肝切除术。


Application of liver hanging maneuver in associating liver partition and portal vein ligation for staged hepatectomy

Abstract

Objective: To investigate the efficacy of using liver hanging maneuver (LHM) in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods: The clinical data of 4 patients with primary liver cancer undergoing ALPPS procedure were retrospectively analyzed. Of the patients, 3 cases had tumor in the right lobe and one case in the caudate lobe. All patients underwent first-stage operation of in situ splitting of the liver parenchyma and right portal vein ligation guided by LHM, and a second-stage of complete tumor removal. Results: In all the 4 patients, the prior hepatic transection, hanging tape positioning and second-stage liver resection were performed successfully. In the first-stage operation, the operative time was 195–273 (232.2±35.3) min, intraoperative blood loss was 420–1 210 (735±344.3) mL, and bile leakage occurred in one case; in the secondstage operation, the operative time was 98–186 (139.5±36.6) min, and intraoperative blood loss was 100–320 (197.5±95.3) mL. No operative death occurred. The patients were followed-up for 3 months, at which time 3 patients were in good condition, and one patient had died of recurrence 2 months after operation. Conclusion: LHM is effective for inferior vena cava protection and clear exposure of the intrahepatic blood vessels and ductal system, so it can be routinely used in ALPPS procedure.


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引用

引用本文: 志明 王, 宽 胡, 群刚 苌, 云 黄, 乐杜 周, 新营 李, 劲东 李, 一明 陶. 绕肝提拉法在联合肝脏离断和门静脉切断二步肝切除术中的应用[J]. 中国普通外科杂志, 2015, 24(1): 12–17.
Cite this article as: WANG Zhiming, HU Kuang, CHANG Qungang, HUANG Yun, ZHOU Ledu, LI Xinying, LI Jingdong, TAO Yiming . Application of liver hanging maneuver in associating liver partition and portal vein ligation for staged hepatectomy [J]. Chin J Gen Surg, 2015, 24(1): 12–17.