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目的探索用余肝体积作为半肝切除的安全标准。方法拟行半肝切除的肝癌病人术前以 CT 测定余肝体积,以病人体表面积计算标准化的肝脏体积。评价病人术后的安全性及其影响因素。结果 2003年12月至2005年3月对拟行半肝切除的病人测定余肝体积25例。以标化余肝体积>250ml 作为耐受半肝切除的标准。实际行半肝切除20例,其中右半肝切除15例,左半肝切除5例。接受右半肝切除的病例 SFLV 和 SFLVR 的中位值分别为298.6ml 和42.2%;在左半肝切除病例组,SFLV 和 SFLXR 的中位值分别为650ml 和91.8%。术后出现并发症9例,其中8例为少量一中等量的腹水,无手术死亡。以腹水定义为术后肝功能不全,结果术中是否输血是术后肝功能不全的惟一影响因素。结论标准化余肝体积>250ml,或标准化余肝体积比例>35%可作为 Child A 的乙型肝炎病人耐受半肝切除的一个指标。
Objective To explore the use of the remaining liver volume as a safety standard for hemihepatectomy. Methods The patients with liver cancer who underwent resection of hepatic resection were preoperatively determined by CT and the normal liver volume was calculated by the body surface area of the patient. Evaluate the patient’s postoperative safety and its influential factors. Results From December 2003 to March 2005, 25 cases of residual liver volume were measured in patients undergoing partial hepatectomy. To standardize the remaining liver volume> 250ml as a semi-hepatic resection tolerance standards. The actual line of hepatectomy in 20 cases, of which 15 cases of right hepatectomy, left hepatectomy in 5 cases. The median SFLV and SFLVR were 298.6 and 42.2% for patients undergoing right hepatectomy and 650 and 91.8% for the left hepatectomy group, respectively. There were 9 cases of postoperative complications, of which 8 cases were a small amount of a moderate amount of ascites, no operative death. Ascites is defined as postoperative liver dysfunction, the results of intraoperative blood transfusion is the only factor of postoperative liver dysfunction. Conclusions The standardized residual liver volume> 250ml, or the normalized residual liver volume ratio> 35%, can be used as an indicator of the tolerance of Hepatitis B patients to Child Hepatectomy.