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目的探讨经肝内Glisson系统入路对合并肝硬化的肝癌病人行肝中叶切除术。方法对2005年5月至2007年12月中南大学湘雅二医院肝胆外科实施24例经肝内Glisson系统入路肝中叶切除术的肝癌病人进行回顾性分析。结果24例经肝内Glisson系统入路肝中叶切除术均安全实施,未发生术中大出血。平均手术时间(258±60)min,平均术中失血量300(200~1200)mL,仅2例输血400mL。术后发生胆漏3例,膈下感染2例,经保守治疗痊愈。无院内死亡病例。结论经肝内Glisson途径的肝中叶切除术治疗合并肝硬化肝癌安全有效,掌握手术技巧是关键。
Objective To investigate the middle hepatic resection for patients with hepatocellular carcinoma complicated with cirrhosis by intrahepatic Glisson system approach. Methods From May 2005 to December 2007, we performed retrospective analysis of 24 patients with hepatocellular carcinoma treated by intrahepatic Glisson system in the middle hepatectomy for hepatobiliary surgery at the Second Xiangya Hospital of Central South University. Results All the 24 cases underwent hepatic midganglionectomy via the Glisson system in the liver. All the patients had no bleeding during operation. The average operation time (258 ± 60) min, the average blood loss during surgery 300 (200 ~ 1200) mL, only 2 cases of blood transfusion 400mL. Postoperative bile leakage in 3 cases, 2 cases of subphrenic infection, cured by conservative treatment. No hospital deaths. Conclusions The middle hepatic resection by the intrahepatic Glisson route is safe and effective in the treatment of liver cancer with cirrhosis. It is the key to master the surgical technique.