CAJ | 학술논문

目的探讨解剖性规则肝段切除术治疗肝中叶泡型包虫病的可行性及临床疗效.方法回顾性分析2013年9月西安交通大学医学院第一附属医院收治的1例肝中叶泡型包虫病患者的临床资料.术前以影像学三维重建技术为基础设计多种手术方案,综合多因素分析(肝脏体积测算、肝实质切除率、血管切除重建评估、Child-Pugh评分和ICG R15等),最终制订解剖性规则肝段切除术方案(肝Ⅴ、Ⅷ、Ⅳb段).术中探查肝包虫囊肿与第一、二肝门关系密切,精细操作,解剖性切除肝Ⅳb、Ⅴ、Ⅷ段.术后每个月通过门诊或电话进行随访,并行B超及CT检查了解肝脏情况,随访时间截至2014年4月.结果术前三维可视化重建后图像清晰立体地显示肿瘤组织、腹腔实质器官、腹腔大血管的解剖结构及毗邻关系,术中证实三维重建的解剖关系与实际基本一致.手术历时410 min,术中出血量约1 000 mL,未输注血液制品;手术过程中患者生命体征平稳.术后患者未出现肝功能不全等并发症.患者术后住院时间为15 d,出院时手术切口愈合良好已拆线,血常规、生化检查结果均正常,恢复正常饮食,生活完全自理.病理学检查结果为肝包虫病(泡型).患者术后持续服用阿苯达唑1 200 mg/d.随访6个月,患者体质量较出院时增加5 kg,无不适主诉,已恢复劳动能力.未发现肝脏包虫病变复发,未发现全身其他器官包虫病发生.结论解剖性规则肝段切除术治疗肝中叶泡型包虫病术中依靠肝实质及血管三维重建方案指引,结合选择性肝门阻断和血管切除重建等关键技术的应用,既完整切除病变肝脏,又保证了剩余肝脏功能性体积最大化,患者术后恢复良好,近期疗效满意.
목적 탐토해부성규칙간단절제술치료간중협포형포충병적가행성급림상료효.방법 회고성분석2013년9월서안교통대학의학원제일부속의원수치적1례간중협포형포충병환자적림상자료.술전이영상학삼유중건기술위기출설계다충수술방안,종합다인소분석(간장체적측산、간실질절제솔、혈관절제중건평고、Child-Pugh평분화ICG R15등),최종제정해부성규칙간단절제술방안(간Ⅴ、Ⅷ、Ⅳb단).술중탐사간포충낭종여제일、이간문관계밀절,정세조작,해부성절제간Ⅳb、Ⅴ、Ⅷ단.술후매개월통과문진혹전화진행수방,병행B초급CT검사료해간장정황,수방시간절지2014년4월.결과 술전삼유가시화중건후도상청석입체지현시종류조직、복강실질기관、복강대혈관적해부결구급비린관계,술중증실삼유중건적해부관계여실제기본일치.수술력시410 min,술중출혈량약1 000 mL,미수주혈액제품;수술과정중환자생명체정평은.술후환자미출현간공능불전등병발증.환자술후주원시간위15 d,출원시수술절구유합량호이탁선,혈상규、생화검사결과균정상,회복정상음식,생활완전자리.병이학검사결과위간포충병(포형).환자술후지속복용아분체서1 200 mg/d.수방6개월,환자체질량교출원시증가5 kg,무불괄주소,이회복노동능력.미발현간장포충병변복발,미발현전신기타기관포충병발생.결론 해부성규칙간단절제술치료간중협포형포충병술중의고간실질급혈관삼유중건방안지인,결합선택성간문조단화혈관절제중건등관건기술적응용,기완정절제병변간장,우보증료잉여간장공능성체적최대화,환자술후회복량호,근기료효만의.
Objective To investigate the efficacy and feasibility of segment-orientated anatomical liver resection for the treatment of hepatic alveolar echinococcosis (HAE) in the middle lobe of the liver.Methods The clinical data of a female patient with HAE in the middle lobe of the liver who was admitted to the First Affiliated Hospital of Xi'an Jiaotong University in September 2013 were retrospectively analyzed.Before operation,various surgical plannings were facilitated by a three-dimensional reconstruction system,and then the surgical planning was determined with the assistance of the multivariate analysis (volume measurement of liver,resectability of remnant functional liver,evaluation of vascular resection and reconstruction,Child-Pugh score and indocyanine green retention at 15 minutes).Segment-orientated anatomical liver resection(segment Ⅴ,Ⅷ and Ⅳb) was performed on the patient.There was a close relationship between the HAE and the first and the second hepatic portal during operation,and the anatomical liver resection of segment Ⅴ,Ⅷ and Ⅳb was precisely carried out.The patient was followed up by outpatient examination and telephone interview every month up to April 2014.The condition of the liver was observed by B ultrasound and computed tomography examinations.Results The three-dimensional reconstruction of the CT data of the patient clearly displayed the anatomical structure and adjacent relationship between the tumor,abdominal organs and major abdominal vessels.The preoperative evaluation of the anatomy of tumor based on three-dimensional images was confirmed with operative findings.The operation time and volume of blood loss were 410 minutes and 1 000 mL,respectively.The patient did not receive blood transfusion.The intraoperative vital signs of the patient were stable.There were no complications such as hepatic insufficiency.The duration of postoperative hospital stay was 15 days.Surgical incision was healed at discharge.The results of blood routine and blood biochemistry test,daily diet and basic self-care ability were in normal condition.HAE was diagnosed based on the result of pathological examination.Albendazole was administered with 1 200 mg/d after operation.The patient was followed up for 6 months and returned to work.The weight of the patient increased by 5 kilograms than that at discharge,without complaint of discomfort.There was no recurrence of HAE and hepatic echinococcosis of organs.Conclusions Segment-orientated anatomical liver resection is not only a method for complete resection,but also maximizes the functional remnant of liver on the basis of intraoperative three-dimensional reconstruction system together with selective hepatic inflow occlusion and vessel reconstruction technique.The patient gets a full recovery with satisfactory outcome.