国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2013年
4期
249-251,封3
,共4页
肝肿瘤%肝后下腔静脉前间隙%血管结扎%肝切除术%治疗%临床研究性
肝腫瘤%肝後下腔靜脈前間隙%血管結扎%肝切除術%治療%臨床研究性
간종류%간후하강정맥전간극%혈관결찰%간절제술%치료%림상연구성
Liver neoplasms%Retrohepatic Tunnel (RT)%Vascular deligation%Hepatectomy%Therapies%Investigation
目的 研究右肝巨大肿瘤患者经右侧肝后下腔静脉前间隙入路逆行解剖结扎肝短静脉和右肝静脉在右半肝切除术中的临床意义.方法 对23例右肝巨大肿瘤(＞8 cm×8 cm)患者,依次采用切开第二肝门分离右肝静脉与中肝静脉间隙,于Glisson氏系统鞘内分离、结扎右半肝门静脉和肝动脉,随后逆行沿右侧肝后下腔静脉前间隙解剖结扎肝短静脉和右肝静脉,最后于肝中线左侧置一阻断带再离断肝中线的右半肝切除术.结果 全组患者在分离右半肝动脉、门静脉、肝后下腔静脉和右肝静脉解剖的右半肝切除术中过程顺利.术中出血量:＜ 400 mL 7例,500～700 mL 11例,800～1 000 mL2例,l 100～1 400 mL13例；平均为640 mL.术后第3天肝功能变化情况:总胆红素20～40 μmol/L 16例,45 ～ 50 μmol/L 6例,60 μmol/L 1例.血清谷丙转氨酶150 ～200 U/L 14例,250 ～ 400 U/L 9例.血清谷草转氨酶160 ～ 200 U/L13例,230 ～400 U/L 9例,430 U/L 1例.r-谷氨酰转肽酶160 ～200 U/L 14例,220 ～310 U/L 8例,420 U/L1例.术后因并发深静脉细菌感染导致肝功能衰竭1例.结论 肿瘤没有直接侵犯膈肌、肝后下腔静脉或肿瘤非特别巨大可选择沿肝后下腔静脉右前间隙逆行解剖结扎肝短静脉和右肝静脉的右半肝切除术方式,可以减少术中出血,有利于术后肝功能的恢复.
目的 研究右肝巨大腫瘤患者經右側肝後下腔靜脈前間隙入路逆行解剖結扎肝短靜脈和右肝靜脈在右半肝切除術中的臨床意義.方法 對23例右肝巨大腫瘤(＞8 cm×8 cm)患者,依次採用切開第二肝門分離右肝靜脈與中肝靜脈間隙,于Glisson氏繫統鞘內分離、結扎右半肝門靜脈和肝動脈,隨後逆行沿右側肝後下腔靜脈前間隙解剖結扎肝短靜脈和右肝靜脈,最後于肝中線左側置一阻斷帶再離斷肝中線的右半肝切除術.結果 全組患者在分離右半肝動脈、門靜脈、肝後下腔靜脈和右肝靜脈解剖的右半肝切除術中過程順利.術中齣血量:＜ 400 mL 7例,500～700 mL 11例,800～1 000 mL2例,l 100～1 400 mL13例；平均為640 mL.術後第3天肝功能變化情況:總膽紅素20～40 μmol/L 16例,45 ～ 50 μmol/L 6例,60 μmol/L 1例.血清穀丙轉氨酶150 ～200 U/L 14例,250 ～ 400 U/L 9例.血清穀草轉氨酶160 ～ 200 U/L13例,230 ～400 U/L 9例,430 U/L 1例.r-穀氨酰轉肽酶160 ～200 U/L 14例,220 ～310 U/L 8例,420 U/L1例.術後因併髮深靜脈細菌感染導緻肝功能衰竭1例.結論 腫瘤沒有直接侵犯膈肌、肝後下腔靜脈或腫瘤非特彆巨大可選擇沿肝後下腔靜脈右前間隙逆行解剖結扎肝短靜脈和右肝靜脈的右半肝切除術方式,可以減少術中齣血,有利于術後肝功能的恢複.
목적 연구우간거대종류환자경우측간후하강정맥전간극입로역행해부결찰간단정맥화우간정맥재우반간절제술중적림상의의.방법 대23례우간거대종류(＞8 cm×8 cm)환자,의차채용절개제이간문분리우간정맥여중간정맥간극,우Glisson씨계통초내분리、결찰우반간문정맥화간동맥,수후역행연우측간후하강정맥전간극해부결찰간단정맥화우간정맥,최후우간중선좌측치일조단대재리단간중선적우반간절제술.결과 전조환자재분리우반간동맥、문정맥、간후하강정맥화우간정맥해부적우반간절제술중과정순리.술중출혈량:＜ 400 mL 7례,500～700 mL 11례,800～1 000 mL2례,l 100～1 400 mL13례；평균위640 mL.술후제3천간공능변화정황:총담홍소20～40 μmol/L 16례,45 ～ 50 μmol/L 6례,60 μmol/L 1례.혈청곡병전안매150 ～200 U/L 14례,250 ～ 400 U/L 9례.혈청곡초전안매160 ～ 200 U/L13례,230 ～400 U/L 9례,430 U/L 1례.r-곡안선전태매160 ～200 U/L 14례,220 ～310 U/L 8례,420 U/L1례.술후인병발심정맥세균감염도치간공능쇠갈1례.결론 종류몰유직접침범격기、간후하강정맥혹종류비특별거대가선택연간후하강정맥우전간극역행해부결찰간단정맥화우간정맥적우반간절제술방식,가이감소술중출혈,유리우술후간공능적회복.
Objective To study the clinical value of anatomizing and ligating the short hepatic veins (SHVs) and right hepatic veins through the right Retrohepatic Tunnel (RT) in right hemibepatectomy of giant hepatic carcinoma.Methods We performed the right hemibepatectomy on 23 patients with huge tumors which diameters were lager than 8 cm.There were four main procedures during the operation.Firstly,sperated the interspace between right hepatic veins and middle hepatic veins through secundum porta hepatis.Secondly,seperated and ligated the right hepatic portal vein and hepatic artery in the Glisson's system.Thirdly,anatomized and ligated SHVs and right hepatic veins through the right RT conversly.Finally,set a blocking-belt at the left of the central liver and then cut the right hemi-hepar.Results The anatomy of right hepatic artery,Portal Vein,retrohepatic inferior vena cava (RHIVC),right hepatic veins was well done.The intraoperative blood loss of 7 patients was less than 400 mL,and 11 was 500-700 mL,2 was 800-1 000 mL,3 was 1 100-1 400 mL,and average was 640 mL.The hepatic function was changed in the third day afteroperation.The numerus of TBIL of 16 patients was 20-40 μmol/L,and 6 was 45-50 μmol/L,and 1 was 60 μmol/L.The numerus of ALT of 14 patients was 150-200 U/L,and 9 was 250-400 U/L.The numerus of AST of of 13 patients was 160-200 U/L,and 9 was 230-400 U/L,and 1 was 430 U/L.The numerus of GGT of 14 patients was 160-200 U/L,and 8 was 220-310 U/L,and 1 was 420 U/L.The hepaticfailure happened to 1 patient because of deep venous infection.Conclusions The right hemibepatectomy through the right retrohepatic tunnel is feasible in the tumor without invasion the RHIVC and diaphragm,or the volume was not too huge.The operation could reduce the blood loss and make for the recovery of hepatic funtions.
