肝叶血流阻断在右肝解剖性肝切除中的应用：附12例报告
| 作者: |
1陈海敏,
2高夫生,
1方路,
1梁博,
1袁荣发,
1郑兵兵,
1付晓伟,
1杜鹏程
1 南昌大学第二附属医院 肝胆胰外科，江西 南昌 330006 2 江西省峡江县人民医院 普通外科，江西 吉安331409 |
| 通讯: |
方路
Email: fanglu@medmail.com.cn |
| DOI: | 10.3978/.2018.01.003 |
| 基金: | 江西省卫生厅科技计划基金资助项目（20131077）；江西省教育厅科学技术基金资助项目（GJJ150260）；江西省科学技术厅重点研发计划资助项目（20171BBG70063）。 |
摘要
目的：探讨肝叶血流阻断在右肝解剖性肝切除中的应用效果。
方法：回顾性分析12例患者的临床资料，其中原发性肝癌8例，肝内胆管结石4例，所有患者病变均局限在右肝肝叶或右肝仅一肝段中，术中均采用肝叶血流阻断行右肝解剖性肝切除。
结果：12例患者手术均顺利完成，其中行肝V段切除1例，肝VII段切除2例，肝VIII段切除3例，右后叶切除4例，右前叶切除2例；平均手术时间（263.33±27.99）min，术中出血量（397.50±85.29）mL。术后并发胸腔积液1例，胆汁漏1例，经保守治疗治愈。所有患者均痊愈出院。
结论：肝叶血流阻断在右肝解剖性肝切除中可有效控制术中出血的同时减轻对肝脏功能的损伤，安全可行。
关键词：
肝切除术/方法；肝肿瘤；胆结石；失血，手术
方法：回顾性分析12例患者的临床资料，其中原发性肝癌8例，肝内胆管结石4例，所有患者病变均局限在右肝肝叶或右肝仅一肝段中，术中均采用肝叶血流阻断行右肝解剖性肝切除。
结果：12例患者手术均顺利完成，其中行肝V段切除1例，肝VII段切除2例，肝VIII段切除3例，右后叶切除4例，右前叶切除2例；平均手术时间（263.33±27.99）min，术中出血量（397.50±85.29）mL。术后并发胸腔积液1例，胆汁漏1例，经保守治疗治愈。所有患者均痊愈出院。
结论：肝叶血流阻断在右肝解剖性肝切除中可有效控制术中出血的同时减轻对肝脏功能的损伤，安全可行。
Application of vascular occlusion of hepatic lobe in anatomical right hepatectomy: a report of 12 cases
CorrespondingAuthor:FANG Lu Email: fanglu@medmail.com.cn
Abstract
Objective: To investigate the application efficacy of vascular occlusion of the hepatic lobe in anatomical right hepatectomy.
Methods: The clinical data of 12 patients were analyzed retrospectively. Of the patients, 8 cases were primary liver cancer and 4 cases were hepatolithiasis. In all the patients, the lesions were confined to the right lobe of the liver or one segment of the right liver. All patients underwent anatomical right hepatectomy with vascular occlusion of the hepatic lobe.
Results: Operations in the 12 patients were all successfully completed, which included segment V resection in one case, segment VII resection in 2 cases, segment VIII resection in 3 cases, right posterior lobectomy in 4 cases and right anterior lobectomy in 2 cases. The average operative time was (263.33±27.99) min, and the average intraoperative blood loss was (397.50±85.29) mL. After operation, hydrothorax and bile leakage occurred in one case each, which were resolved by conservative treatment. All patients recovered and were discharged from the hospital.
Conclusion: Using vascular occlusion of the hepatic lobe in anatomical right hepatectomy can effectively control the intraoperative bleeding and reduce the liver function damage, so it is safe and feasible.
Keywords：
Hepatectomy/methods; Liver Neoplasms; Cholelithiasis; Blood Loss
Surgical
Methods: The clinical data of 12 patients were analyzed retrospectively. Of the patients, 8 cases were primary liver cancer and 4 cases were hepatolithiasis. In all the patients, the lesions were confined to the right lobe of the liver or one segment of the right liver. All patients underwent anatomical right hepatectomy with vascular occlusion of the hepatic lobe.
Results: Operations in the 12 patients were all successfully completed, which included segment V resection in one case, segment VII resection in 2 cases, segment VIII resection in 3 cases, right posterior lobectomy in 4 cases and right anterior lobectomy in 2 cases. The average operative time was (263.33±27.99) min, and the average intraoperative blood loss was (397.50±85.29) mL. After operation, hydrothorax and bile leakage occurred in one case each, which were resolved by conservative treatment. All patients recovered and were discharged from the hospital.
Conclusion: Using vascular occlusion of the hepatic lobe in anatomical right hepatectomy can effectively control the intraoperative bleeding and reduce the liver function damage, so it is safe and feasible.