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目的探讨累及多肝门的巨大肝肿瘤切除的安全性、可行性及手术方法。方法总结1996年4月至2003年4月间我科收治的累及多肝门的巨大肝肿瘤22例,肿瘤平均直径12.9 cm(8~23 cm)。肿瘤同时累及第1和第3肝门者9例,同时侵及第2、3肝门者8例,累及1、2、3肝门者5例。肝肿瘤包括:原发性肝细胞癌14例,胆管细胞癌1例,肝血管瘤4例,肝母细胞瘤3例。癌灶有完整包膜12例(55.5%),无完整包膜10例(45.5%)。对肝肿瘤所施手术方法、并发症防治等进行分析。结果全部病例均手术切除,无手术死亡,术中平均出血量1 480 ml(450~4 200 ml),12例施行第1肝门阻断,10例采用了肝门区域选择性血管阻断,手术时间平均195 min。术后无严重并发症,均治愈出院。本组22例病人经1~8年随访,术后存活时间最长已达8年,1年生存率为90.9%(20/22)。结论对于累及多肝门的巨大肝肿瘤,只要正确把握手术指征,熟练掌握切肝技术,手术切除是安全的、可行的最佳治疗手段。
Objective To investigate the safety, feasibility and operation of giant liver tumor involving multiple hilar tumors. Methods From April 1996 to April 2003, 22 cases of giant liver tumors involving in multiple hilar tumors were treated in our department. The mean tumor diameter was 12.9 cm (8-23 cm). There were 9 cases with tumors involving both the first and third hysterome tumors, 8 cases with infracted second and third hilar tumors, and 5 cases with involvement of the hilar and the second hilar. Liver tumors include: primary hepatocellular carcinoma in 14 cases, cholangiocarcinoma in 1 case, hepatic hemangioma in 4 cases and hepatoblastoma in 3 cases. Focal lesions in 12 cases (55.5%), no complete capsule in 10 cases (45.5%). The surgical methods, complications prevention and treatment of liver tumors were analyzed. Results All the cases were surgically removed without surgery, with an average intraoperative blood loss of 1,480 ml (450-4,200 ml), 12 cases of hepatic hilar block and 10 cases of hepatic portal selective vasoconstriction. The average operation time was 195 min. No serious complications after surgery were cured. The group of 22 patients after 1 to 8 years follow-up, the longest survival time has reached 8 years, 1-year survival rate was 90.9% (20/22). Conclusions For giant liver tumors involving multiple hysterons, as long as the correct operation of the indications, master the hepatectomy, surgical resection is safe and feasible the best treatment.