CAJ | 학술논문

解剖性肝切除不但能够保证足够的无瘤切缘,而且还能最大限度地保留非肿瘤肝组织.2012年2月,海南医学院附属医院运用选择性肝血流阻断技术成功为1例61岁的男性多发原发性肝癌患者行解剖性肝Ⅵ、Ⅶ、Ⅷ段切除术.术前CT检查示肝Ⅵ、Ⅶ、Ⅷ段多发占位性病变,三维重建测算左半肝体积少于最小存活肝脏体积.为了最大限度保留剩余肝脏,拟行保留Ⅴ段的解剖性肝Ⅵ、Ⅶ、Ⅷ段切除术.术中运用了两次Glisson蒂阻断技术,解剖出右半肝和右后叶的Glisson蒂,从而确定肝Ⅵ、Ⅶ、Ⅷ段的切除范围,完成了解剖性肝Ⅵ、Ⅶ、Ⅷ段切除.区域性的入肝血流阻断技术是减轻肝脏的缺血再灌注损伤的关键,对手术的顺利完成及患者术后恢复都至关重要.
해부성간절제불단능구보증족구적무류절연,이차환능최대한도지보류비종류간조직.2012년2월,해남의학원부속의원운용선택성간혈류조단기술성공위1례61세적남성다발원발성간암환자행해부성간Ⅵ、Ⅶ、Ⅷ단절제술.술전CT검사시간Ⅵ、Ⅶ、Ⅷ단다발점위성병변,삼유중건측산좌반간체적소우최소존활간장체적.위료최대한도보류잉여간장,의행보류Ⅴ단적해부성간Ⅵ、Ⅶ、Ⅷ단절제술.술중운용료량차Glisson체조단기술,해부출우반간화우후협적Glisson체,종이학정간Ⅵ、Ⅶ、Ⅷ단적절제범위,완성료해부성간Ⅵ、Ⅶ、Ⅷ단절제.구역성적입간혈류조단기술시감경간장적결혈재관주손상적관건,대수술적순리완성급환자술후회복도지관중요.
Anatomic hepatic resection not only enables enough tumor-free resection margin,but also guarantee the maximal remnant of normal liver tissue.A 61-year-old male patient with hepatic cancer was admitted to the Affiliated Hospital of Hainan Medical College in February 2012.Multiple space-occupying lesions were found in segment Ⅵ,Ⅶ and Ⅷ by computed tomography (CT).The results of CT volumetry analysis showed that the left hemihepatic volume was lesser than the minimal limit of survival,so anatomic hepatic segmentectomy of Ⅵ,Ⅶ and Ⅷ with preservation of segment Ⅴ was designed to guarantee the maximal remaining of normal liver tissue.Glisson's pedicle transection was used twice to divide the right hemihepatic Glisson's pedicle,segment Ⅵ and Ⅶ Glisson's pedicle,respectivley,then the resection line was determined,and anatomical hepatic segmentectomy of Ⅵ,Ⅶ and Ⅷ was completed.With the procedures adopted,the hepatic ischemia reperfusion injury and hemodynamic instability were maximally reduced during operation.