CAJ | 학술논문

目的对四川大学华西医院近3年开展的30例小儿肝脏巨大肿瘤精准切除病例进行总结分析.方法 2009年1月至2012年2月小儿外科共实施肝脏巨大肿瘤精准切除30例,男17例,女13例,年龄2个月～14岁,平均(5.04±3.50)岁.其中肝母细胞瘤13例,肝脏局灶性增生5例,肝血管瘤3例,肝错构瘤3例,其他6例.所有病例术前进行肝脏储备功能及影像学的仔细评估,术中采用先进的手术方法及器械精细断肝,并将其治疗效果与传统肝切除法进行比较.结果精准肝切除组失血量(193.00±103.76) ml及输血量(210.83±133.66)ml显著少于传统肝切除组的(358.60±192.56)ml和(436.80±282.75)ml(P＜0.01)；谷丙转氨酶及总胆红素平均恢复时间分别为(8.13±1.74)d和(6.50±1.87)d,明显短于传统肝切除组的(10.80±2.81)d和(8.96±3.21)d(P＜0.01)；ICU滞留时间及住院时间为(2.12±0.68)d和(11.43±1.92)d,也短于传统肝切除组的(2.56±1.36)d和(14.52±3.94)d(P＜0.05).精准肝切除组患儿术后并发症率33.3％,低于传统肝切除组76.0％,术后无死亡、肝功能衰竭、腹腔内大出血及腹腔感染发生,仅有10例患儿出现轻度胆漏、胸腔积液及肺部感染.结论精准肝切除是治疗小儿巨大肝脏肿瘤安全有效的方法.出血量少,肝功能恢复快,术后并发症率低,住院时间短.
목적 대사천대학화서의원근3년개전적30례소인간장거대종류정준절제병례진행총결분석.방법 2009년1월지2012년2월소인외과공실시간장거대종류정준절제30례,남17례,녀13례,년령2개월～14세,평균(5.04±3.50)세.기중간모세포류13례,간장국조성증생5례,간혈관류3례,간착구류3례,기타6례.소유병례술전진행간장저비공능급영상학적자세평고,술중채용선진적수술방법급기계정세단간,병장기치료효과여전통간절제법진행비교.결과 정준간절제조실혈량(193.00±103.76) ml급수혈량(210.83±133.66)ml현저소우전통간절제조적(358.60±192.56)ml화(436.80±282.75)ml(P＜0.01)；곡병전안매급총담홍소평균회복시간분별위(8.13±1.74)d화(6.50±1.87)d,명현단우전통간절제조적(10.80±2.81)d화(8.96±3.21)d(P＜0.01)；ICU체류시간급주원시간위(2.12±0.68)d화(11.43±1.92)d,야단우전통간절제조적(2.56±1.36)d화(14.52±3.94)d(P＜0.05).정준간절제조환인술후병발증솔33.3％,저우전통간절제조76.0％,술후무사망、간공능쇠갈、복강내대출혈급복강감염발생,부유10례환인출현경도담루、흉강적액급폐부감염.결론 정준간절제시치료소인거대간장종류안전유효적방법.출혈량소,간공능회복쾌,술후병발증솔저,주원시간단.
Objective To summarize our experience on precise liver resection for giant pediatric hepatic neoplasms.Methods From January 2009 to February 2012,30 patients underwent precise liver resection technique for resection of giant hepatic neoplasm at West-China hospital of Sichuan University.The patients,consisting of 17 boys and 13 girls,had an average age of 5.04 ± 3.50 years (range,2months to 14 years).Hepatic reserve function and radiologic study were evaluated carefully before surgery.Individualized surgical approach was carefully planned.Postoperative pathology diagnoses were hepatoblastoma in 13,focal liver hyperplasia in 5,hepatic hemangioma in 3,liver hamartoma in 3,and other in 6.The outcome of precise liver resection technique was evaluated by comparing with the out come of conventional liver resections.Results Compared with conventional liver resection,patients underwent precise liver resections had less mean blood loss and blood transfusion (P＜ 0.01),faster decline in alanine aminotransferase,sooner recovery in total bilirubin levels (P＜ 0.01),and shorter ICU/hospital stays (P＜ 0.05).The precise liver resections were associated with fewer complications than conventional liver resection.No liver failure,intra-abdominal bleeding,abdominal infection,or death was noted.Ten patients had minor complications,including mild bile leakage,hydrothorax,and pulmonary infection.Conclusions Precise liver resection is safe and effective for the treatment of giant hepatic neoplasms in children.