CAJ | 학술논문

目的探讨持久亚甲蓝染色法在肝细胞癌合并胆管癌栓患者的解剖性肝切除术中的应用价值.方法 2009年1月至2011年2月对11例肝细胞癌合并胆管癌栓患者实施解剖性肝切除术和胆管取癌栓术.其中男性10例,女性1例；年龄31～67岁,平均年龄49岁.9例以黄疸为首发临床表现.按Satoh分型Ⅰ型3例,Ⅱ型7例,Ⅲ型1例.在肝门部解剖出预切除肝段的蒂,向Glisson　鞘内门静脉远端注射亚甲蓝后结扎该蒂,使预切除肝段染色,按着色的界限行肝段切除.结果　11例手术均染色成功,实施肝段切除4例,肝亚段切除3例,半肝切除2例,肝叶切除2例.平均手术时间137 min,平均术中出血量246 ml.术后均无肝功能不全等严重并发症发生,无围手术期死亡.平均随访14.6个月,2例出现肝脏肿瘤复发,l例发生肿瘤腹腔种植,1例复发胆管癌栓,2例死亡.结论　采用持久亚甲蓝染色法肝切除术治疗肝细胞癌合并胆管癌栓能提高肝切除的精准性.
목적 탐토지구아갑람염색법재간세포암합병담관암전환자적해부성간절제술중적응용개치.방법 2009년1월지2011년2월대11례간세포암합병담관암전환자실시해부성간절제술화담관취암전술.기중남성10례,녀성1례；년령31～67세,평균년령49세.9례이황달위수발림상표현.안Satoh분형Ⅰ형3례,Ⅱ형7례,Ⅲ형1례.재간문부해부출예절제간단적체,향Glisson　초내문정맥원단주사아갑람후결찰해체,사예절제간단염색,안착색적계한행간단절제.결과　11례수술균염색성공,실시간단절제4례,간아단절제3례,반간절제2례,간협절제2례.평균수술시간137 min,평균술중출혈량246 ml.술후균무간공능불전등엄중병발증발생,무위수술기사망.평균수방14.6개월,2례출현간장종류복발,l례발생종류복강충식,1례복발담관암전,2례사망.결론　채용지구아갑람염색법간절제술치료간세포암합병담관암전능제고간절제적정준성.
Objective To evaluate the role of anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method.Methods From January 2009 to February 2011,11 hepatocellular carcinoma patients with bile duct tumor thrombi underwent anantomic hepatotectomy with removal of the biliary tumor thrombus.There were 10 male and 1 female patients.The average age was 49 years ( ranging from 31 to 67 years).The initial symptom of 9 out of the 11 patients was jaundice. After anatomy and ligation of Glissonean pedicle of pre-resection segment,methylene blue was injected into its far-end portal vein in order to dye the segment,Results Persistent methylene blue dyeing method was successful in all patients. Primary foci were found in all patients.Hepatotectomy were performed,including 4 patients of segmentectomy,3 patients of subsegmentectomy,2 patients of hemihepatectomy,and 2 patients of hepatic sectorectomy.The mean operation time and blood loss was 137 minutes and 246 ml respectively.Severe complications such as liver function failure and sub-diaphragm abscess was avoided in all patients.No perioperative death.Post-operation radiotherapy was performed on 2 patients.Over a mean follow-up time of 14.6 months,liver cancer recurrence occured in 2 patients,abdomen seeding metastasis in 1 patient,bile duct tumor thrombi recurrence in 1 case,and 2 patients died.Conclusions Anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method can make resection more precise and improve curative effect.