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目的小儿巨大肝肿瘤切除术中,常规行肝门阻断,本研究对不阻断肝门行巨大肝肿瘤切除术进行探讨。方法从2001年7月至2004年12月,我院对16例患儿施行不阻断肝门巨大肝肿瘤切除术,患儿年龄28d~14岁,平均3.4岁。其中男12例,女4例,肿瘤直径11~23cm,平均14.6cm,其中右半肝和左外叶内分别有一肿块1例。肝母细胞瘤9例,肝错构瘤4例,肝血管瘤3例。结果本组16例患儿手术全部成功,不阻断肝门行右半肝(Ⅴ~Ⅷ)切除8例,右三叶切除4例,左三叶切除1例,左半肝切除1例,第二肝门及右下叶肝段切除各1例。患儿术中无死亡,血流动力学指标稳定。本组良性巨大肝肿瘤患儿术后随访7个月~3.5年,目前均健康生存,无肿瘤复发,生长发育正常;肝母细胞瘤9例患儿术后常规化疗,患儿已经随访6~45个月,目前无瘤生存8例,2年以上4例,肝功能正常,正常生活。另外1例左外叶和右叶同时发现肝母细胞瘤,手术分别切除后5个月脑肺转移,于术后7个月死亡。结论不阻断肝门巨大肝肿瘤切除术,是一种安全可行的手术。术者熟练的肝脏解剖知识和肝切除技术、紧密结合术前和术中影像学技术了解肿瘤与大血管关系、彻底结扎肿瘤侧入肝肝动脉和门静脉及肝左右静脉共干或肝右静脉,是手术成功的关键。
Purpose In pediatric giant hepatic tumor resection, hepatic portal is routinely performed in this study. Methods From July 2001 to December 2004, 16 cases of children with giant hepatic resection of hepatic hilar were treated in our hospital. The children were 28 to 14 years old with an average of 3.4 years. Including 12 males and 4 females, the tumor diameter of 11 ~ 23cm, an average of 14.6cm, of which a right lump and the left outer lobes were a mass in 1 case. Hepatoblastoma in 9 cases, liver hamartoma in 4 cases, 3 cases of hepatic hemangioma. Results The operation was successful in all 16 cases. There were 8 cases of right hepatic debridement (Ⅷ ~ Ⅷ), 4 cases of right trilobectomy, 1 case of left trilobectomy, 1 case of left hepatectomy, The second hilar and right lower lobe liver resection in 1 case. No death in children, hemodynamic indicators of stability. This group of benign giant liver tumor patients were followed up for 7 months to 3.5 years, are currently healthy to live without tumor recurrence, growth and development of normal; 9 patients with hepatoblastoma conventional chemotherapy after surgery, children have been followed up 6 ~ 45 months, no tumor-free survival in 8 cases, more than 2 years in 4 cases, normal liver function, normal life. Another case of left outer lobe and right lobe at the same time found in hepatoblastoma, 5 months after surgical excision of brain metastases, 7 months after the death. Conclusion It is a safe and feasible procedure to not block the hepatic giant tumor resection. The surgeon skilled in liver anatomy and liver resection technology, combined with preoperative and intraoperative imaging techniques to understand the relationship between the tumor and the large vessels, complete ligation of the tumor side of the hepatic artery and portal vein and left and right hepatic vein co-dry or right hepatic vein, Is the key to successful operation.