CAJ | 학술논문

目的肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除作为新的手术方式,替代右半肝切除,治疗位于肝脏Ⅶ-Ⅷ段侵犯肝右静脉的肿瘤.探讨肝脏Ⅶ-Ⅷ段联合肝右静脉切除的可行性、安全性.方法回顾性分析13例肝脏Ⅶ-Ⅷ段肿瘤侵犯肝右静脉,行肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除的手术情况,术后恢复及预后.结果全部13例患者均安全施行肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除,未重建肝右静脉.手术耗时90～ 215 min;出血100～700 ml.术后病理显示肝细胞癌6例,肝内胆管细胞癌1例,肝转移癌4例,肝海绵状血管瘤2例.全组13例术后均顺利恢复,无严重合并症发生.3例出现第Ⅵ段血运障碍,实质萎缩,但无肝功能异常.结论不重建肝右静脉的肝脏Ⅶ-Ⅷ段联合肝右静脉切除安全可行.
목적 간장Ⅶ-Ⅷ단연합간우정맥주간절제작위신적수술방식,체대우반간절제,치료위우간장Ⅶ-Ⅷ단침범간우정맥적종류.탐토간장Ⅶ-Ⅷ단연합간우정맥절제적가행성、안전성.방법 회고성분석13례간장Ⅶ-Ⅷ단종류침범간우정맥,행간장Ⅶ-Ⅷ단연합간우정맥주간절제적수술정황,술후회복급예후.결과 전부13례환자균안전시행간장Ⅶ-Ⅷ단연합간우정맥주간절제,미중건간우정맥.수술모시90～ 215 min;출혈100～700 ml.술후병리현시간세포암6례,간내담관세포암1례,간전이암4례,간해면상혈관류2례.전조13례술후균순리회복,무엄중합병증발생.3례출현제Ⅵ단혈운장애,실질위축,단무간공능이상.결론 불중건간우정맥적간장Ⅶ-Ⅷ단연합간우정맥절제안전가행.
Objective Bisegmentectomy Ⅶ-Ⅷ can be an alternative option for the tumor localized in segments Ⅶ and Ⅷ and infiltrating the main trunk of RHV instead of a right hemihepatectomy.This study was to evaluate the safety and practicability of the removal of segments Ⅶ and Ⅷ of the liver with the resection of the main trunk of RHV without vascular reconstruction.Method 13 consecutive patients underwent bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV between Nov.2006 and Dec.2012 at Beijing Cancer Hospital 1st Department.of HPB Surgery.Results Bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV was performed in all 13 patients successfully without the distal vein reconstruction.The duration of the operations was 90-215 min.Mean blood loss was estimated to be 200 ml (100-700 ml).Indications for a bisegmentectomy Ⅶ-Ⅷ included hepatocellular carcinoma in 6 cases,intrahepatic cholangiocarcinoma in one,liver metastasis in 4 and hepatic hemangioma in 2 as confirmed pathologically.All patients recovered without severe complications.The atrophy of segment Ⅵ due to the venous drainage obstacle was observed in 3 patients without the dysfunction of liver postoperatively.Conclusions It is safe and practicable to perform Ⅶ and Ⅷ bisegmentectomy with resection of the right hepatic vein without vascular reconstruction for liver tumors.