CAJ | 학술논문

目的提高肝中央型大肿瘤的切除率及手术安全性.方法采用肝区域血流选择性适时阻断技术对133例肝中央型大肿瘤患者行肝中央型大肿瘤或肝段切除.结果 133例肿瘤均予完整切除,手术死亡1例.术中44例肝区域血流一次性全阻断12 ～33 min;23例左、右肝血流分别阻断一次者,共阻断8～50 min；一次右侧入肝血流阻断最长者40 min.132例患者的术中出血量为(665±424)ml,其中94例肝原发癌合并肝硬化患者的术中出血量为(723±479)ml,38例无肝硬化患者的术中出血量为(458 ±223) ml,差异有统计学意义(P＜0.01).132例患者中,有122例(92.4％)患者于术后1周内肝功能恢复至Child A级,术后无肝功能衰竭发生.术后有3例患者出现腹水,其中2例并发肝细胞性黄疸(均为肝细胞肝癌合并肝硬化),1例术前做肝动脉介入治疗2次.术后发生胆瘘4例,胃瘫1例,门静脉及肠系膜上静脉血栓1例,右侧胸腔积液5例.112例原发性肝癌患者的1、3、5年生存率分别为89.1％、57.7％和36.9％.结论在肝中央型大肿瘤手术中,采用肝区域血流选择性、适时阻断技术能有效地控制切肝时的出血量,最大限度地减少肝组织缺血、缺氧时间,有利于保护肝细胞功能,患者术后肝功能恢复快,是一种安全的肝血流阻断方法.
목적 제고간중앙형대종류적절제솔급수술안전성.방법 채용간구역혈류선택성괄시조단기술대133례간중앙형대종류환자행간중앙형대종류혹간단절제.결과 133례종류균여완정절제,수술사망1례.술중44례간구역혈류일차성전조단12 ～33 min;23례좌、우간혈류분별조단일차자,공조단8～50 min；일차우측입간혈류조단최장자40 min.132례환자적술중출혈량위(665±424)ml,기중94례간원발암합병간경화환자적술중출혈량위(723±479)ml,38례무간경화환자적술중출혈량위(458 ±223) ml,차이유통계학의의(P＜0.01).132례환자중,유122례(92.4％)환자우술후1주내간공능회복지Child A급,술후무간공능쇠갈발생.술후유3례환자출현복수,기중2례병발간세포성황달(균위간세포간암합병간경화),1례술전주간동맥개입치료2차.술후발생담루4례,위탄1례,문정맥급장계막상정맥혈전1례,우측흉강적액5례.112례원발성간암환자적1、3、5년생존솔분별위89.1％、57.7％화36.9％.결론 재간중앙형대종류수술중,채용간구역혈류선택성、괄시조단기술능유효지공제절간시적출혈량,최대한도지감소간조직결혈、결양시간,유리우보호간세포공능,환자술후간공능회복쾌,시일충안전적간혈류조단방법.
Objective To improve the resection rate and increase operation safety for large centrally located liver tumors.Methods Clinical data from 133 patients with large centrally located liver tumors confirmed by surgery were analyzed retrospectively.Selective and timely regional hepatic vascular occlusion was used during the operation procedure.Results The resection rate was 100％.Perioperative death occurred in one patient.During operations,Forty-four patients underwent regional hepatic inflow occlusion ranging from 12 to 33 minutes.Twenty-three patients underwent left and right inflow occlusion,respectively,ranging from 8 to 50 minutes.One patient had right half-hepatic vascular exclusion for 40 minutes.The blood loss of 132 patients was (665 ± 424) ml (one patient experienced diffuse blood oozing and died in the next day).Among them,the blood loss of patients with liver cirrhosis was (723 ±479) ml.On the contrary,those without liver cirrhosis was (458 ± 223) ml (P ＜ 0.01).Liver function in 92.4％ (122/132) patients recovered to Child-Pugh A within one week.No liver failure occurred.After operation,3 patients presented ascites.Among them,two patients had liver cirrhosis and hepatocellular jaundice,one patient was accepted for transcatheter arterial chemoembolization preoperatively.Four patients had biliary fistula,one patient had gastroparesis,one patient had thrombus in the superior mesenteric vein and portal vein,and five patients had right pleural effusion.The 1-,3-and 5-year survival rates of 112 patients were 89.1％,57.7％ and 36.9％,respectively.Conclusions Selective and timely regional hepatic vascular occlusion is useful for the resection of large centrally located liver tumors.This kind of procedure can effectively control the blood loss during the operation and shorten the ischemic reperfusion time,beneficial for protecting the liver cell function.This procedure is a safe hepatic flow occlusion method.