CAJ | 학술논문

目的探讨肝尾状叶良性肿瘤的手术疗效.方法回顾性分析2003年1月至2014年4月第二军医大学附属东方肝胆外科医院收治的1 12例肝尾状叶良性肿瘤患者的临床资料.根据肿瘤部位、大小等选择采用左侧入路、右侧入路、双侧入路、中央前入路或逆行肝尾状叶切除术.采用门诊或电话方式进行随访,随访时间截至2014年10月.结果 112例患者均具有手术治疗的适应证,均完整切除肿瘤,其中行单纯肝尾状叶肿瘤切除术33例(22例双侧入路、11例左侧入路),左半肝+尾状叶切除术28例(左侧入路),肝中叶+尾状叶切除术21例(中央前入路),部分肝右叶+尾状叶切除术19例(右侧入路),右半肝+尾状叶切除术11例(9例右侧入路、2例逆行切除).术中单纯入肝血流阻断72例,入肝血流联合肝静脉阻断29例,全肝血流阻断6例,未行肝血流阻断5例.手术时间为(192±69) min,平均入肝血流阻断时间为28 min(0 ～94 min),平均术中出血量为590 mL(100～ 12 000 mL),术中输血例数为68例,平均输血量为600 mL(200 ～ 10 000 mL),术后住院时间为(8.2±2.7)d.31例患者术后发生并发症,其中胆汁漏21例,中等量以上胸腔积液7例,术后出血2例,均经对症处理后痊愈;肝衰竭1例,经保肝治疗后好转.无围术期死亡患者.112例患者均获得术后随访,中位随访时间为12个月(6～24个月).随访期间,112例患者均健康生存,无一例患者肿瘤复发或因手术相关并发症死亡.结论手术切除是治疗肝尾状叶良性肿瘤的有效手段,患者术后恢复良好,手术疗效确切.严格把握手术适应证,合理优化手术路径,术中采用选择性肝血流阻断,精细操作是手术成功的关键.
목적 탐토간미상협량성종류적수술료효.방법 회고성분석2003년1월지2014년4월제이군의대학부속동방간담외과의원수치적1 12례간미상협량성종류환자적림상자료.근거종류부위、대소등선택채용좌측입로、우측입로、쌍측입로、중앙전입로혹역행간미상협절제술.채용문진혹전화방식진행수방,수방시간절지2014년10월.결과 112례환자균구유수술치료적괄응증,균완정절제종류,기중행단순간미상협종류절제술33례(22례쌍측입로、11례좌측입로),좌반간+미상협절제술28례(좌측입로),간중협+미상협절제술21례(중앙전입로),부분간우협+미상협절제술19례(우측입로),우반간+미상협절제술11례(9례우측입로、2례역행절제).술중단순입간혈류조단72례,입간혈류연합간정맥조단29례,전간혈류조단6례,미행간혈류조단5례.수술시간위(192±69) min,평균입간혈류조단시간위28 min(0 ～94 min),평균술중출혈량위590 mL(100～ 12 000 mL),술중수혈례수위68례,평균수혈량위600 mL(200 ～ 10 000 mL),술후주원시간위(8.2±2.7)d.31례환자술후발생병발증,기중담즙루21례,중등량이상흉강적액7례,술후출혈2례,균경대증처리후전유;간쇠갈1례,경보간치료후호전.무위술기사망환자.112례환자균획득술후수방,중위수방시간위12개월(6～24개월).수방기간,112례환자균건강생존,무일례환자종류복발혹인수술상관병발증사망.결론 수술절제시치료간미상협량성종류적유효수단,환자술후회복량호,수술료효학절.엄격파악수술괄응증,합리우화수술로경,술중채용선택성간혈류조단,정세조작시수술성공적관건.
Objective To evaluate the surgical efficacy of benign tumor of liver in the caudate lobe.Methods The clinical data of 112 patients with benign tumor of liver in the caudate lobe who were admitted to the Eastern Hepatobiliary Surgery Hospital from January 2003 to April 2014 were retrospectively analyzed.The leftsided approach,right-sided approach,bilateral approach,central anterior approach and retrograde caudate lobectomy were selected according to the location and size of the tumor.All the patients were followed up by outpatient examination and telephone interview up to October 2014.Results Of all the 112 patients who received complete resection of tumor,33 patients received caudate lobectomy (22 by bilateral approach,11 by left-sided approach),28 received left hemihepatectomy + caudate lobectomy (by left-sided approach),21 received mesohepatectomy + caudate lobectomy (by central anterior approach),19 received partial right hepatectomy + caudate lobectomy (by right-sided approach),11 received right hemihepatectomy + candate lobectomy (9 by right-sided approach,2 by retrograde caudate lobectomy).During the operation,72 patients received vascular inflow occlusion,29 received vascular inflow occlusion combined with hepatic veins occlusion,6 received total hepatic vascular exclusion and 5 did not receive vascular inflow occlusion.The operation time,mean time of vascular inflow occlusion,mean volume of intraoperative blood loss,cases of blood transfusion,mean volume of blood transfusion and duration of postoperative hospital stay were (192 ± 69)minutes,28 minutes (range,0-94 minutes),590 mL (range,100-12 000 mL),68,600 mL (range,200-10 000mL) and (8.2 ± 2.7) days,respectively.Thirty-one patients had postoperative complications,including 21 with bile leakage,7 with medium and above volume of pleural effusion,2 with postoperative bleeding and 1 with hepatic failure.The complications were cured after symptomatic treatment.No patient died perioperatively.All the 112 patients were followed up for a median time of 12 months (range,6-24 months).All patients were survived well and without tumor recurrence during the follow-up.Conclusions Surgical treatment is an effective method for benign tumor of liver in the caudate lobe,with the good recovery of patients and definitive surgical efficacy.The key factors of surgical treatment include strictly following operative indication,rationally optimizing surgical approach,suitably selecting vascular inflow occlusion and the accurate operation.