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目的探讨肝脏三叶切除术的手术技术。方法回顾性分析第二军医大学东方肝胆外科医院2000年1月至2005年12月行肝脏三叶切除60例病人的临床资料。结果全组术前肝功能Child-Pugh分级均属A级,57例(95%)评为5分,3例(5%)评为6分。肿瘤直径平均15.2(5～27)cm,其中<15cm14例,15~20cm34例,>20cm12例。行左三叶切除24例,右三叶切除36例。联合尾状叶切除1例、门静脉取栓3例、下腔静脉取栓+右肾上腺切除1例、胆管切开取栓2例、淋巴结清扫4例。60例均行常温下第一肝门阻断法切肝,阻断1次者30例,2次者15例,3次者15例。阻断总时间最长73min,平均30.1min;单次阻断最长45min。术中出血最少200mL,最多11000mL,平均1605mL。输血最多13200mL,平均2003mL。未输血者15例。术后并发症发生率为13.3%(8/60),手术死亡率为3.3%(2/60)。结论肝三叶切除是治疗肝脏肿瘤的有效方法,术前对肝脏储备功能的准确评估是术后肝功能恢复的保证。术野良好的暴露,肝创面的妥善处理及对残肝内重要结构的保护,是减少术后并发症的重要保证。
Objective To investigate the surgical technique of hepatic trilobectomy. Methods The clinical data of 60 patients with hepatic trilobectomy from January 2000 to December 2005 at the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University were retrospectively analyzed. Results The preoperative liver function Child-Pugh grading was grade A, with 57 (95%) rated as 5 and 3 (5%) rated as 6. Tumor diameter average 15.2 (5 ~ 27) cm, of which <15cm14 cases, 15 ~ 20cm34 cases,> 20cm12 cases. Twenty-four patients underwent left-sided three-lobe resection and 36 patients underwent right three-lobe resection. One case of caudate lobe resection, three cases of portal vein thrombectomy, inferior vena cava thrombectomy + right adrenalectomy in 1 case, bile duct incision and thrombectomy in 2 cases, lymph node dissection in 4 cases. 60 cases underwent the first hepatic portal vein occlusion at room temperature, 30 cases were blocked once, twice in 15 cases and 3 times in 15 cases. Blocking the longest total 73min, an average of 30.1min; a single block up to 45min. Intraoperative bleeding at least 200mL, up to 11000mL, an average of 1605mL. Transfusion of up to 13200mL, an average of 2003mL. No blood transfusion in 15 cases. The postoperative complication rate was 13.3% (8/60) and the operative mortality rate was 3.3% (2/60). Conclusions Hepatic trefoil resection is an effective method for the treatment of liver tumors. Accurate assessment of liver reserve function before surgery is the guarantee of postoperative recovery of liver function. Good surgical field exposure, proper management of liver wounds and the protection of important structures in the residual liver are important guarantees for reducing postoperative complications.