CAJ | 학술논문

目的：探讨并总结应用精准肝切除技术治疗肝脏肿瘤的临床经验和应用体会。方法2013年1月至2014年1月应用解剖性精准肝切除技术治疗肝脏良、恶性肿瘤和肝脏其他疾病32例。术前进行肝功能、肝脏储备功能的测定、肝脏预留体积的综合评估，影像学检查仔细研究肝脏肿瘤和肝脏血管、胆管的关系，恶性肿瘤要判断能否做到R0切除。对手术时间、术中出血量、术后肝功能变化、手术后相关性并发症、疾病的转归等方面进行分析和研究。结果所有病人均完成解剖性精准肝切除术，平均手术时间为213.91分钟，术中出血量124.44ml。手术后肝脏功能恢复情况，术后第1天AST、ALT、TBIL和白蛋白变化明显，至手术后第7天基本恢复至正常，表明精准肝切除术对肝功能影响轻微。肝切除术后相关性并发症发生率为21.87%，其中主要为发生肝功能衰竭、胆漏、腹水、胸水和肺炎。所有并发症均经保守治疗治愈。结论精准肝切除符合肝脏恶性肿瘤的根治性切除的原则，可以直观显示肝脏血管与肝脏病变的关系，最大限度的保留正常肝脏实质。由于已经结扎了所切除肝段的入肝血流，明显减少离断肝实质时的出血，可以不阻断第一肝门血流，对保留的肝脏实质无缺血性损伤，手术后肝功能损伤轻微，从而提高了肝切除手术的安全性，明显减少了围手术期的并发症发生率。
목적：탐토병총결응용정준간절제기술치료간장종류적림상경험화응용체회。방법2013년1월지2014년1월응용해부성정준간절제기술치료간장량、악성종류화간장기타질병32례。술전진행간공능、간장저비공능적측정、간장예류체적적종합평고，영상학검사자세연구간장종류화간장혈관、담관적관계，악성종류요판단능부주도R0절제。대수술시간、술중출혈량、술후간공능변화、수술후상관성병발증、질병적전귀등방면진행분석화연구。결과소유병인균완성해부성정준간절제술，평균수술시간위213.91분종，술중출혈량124.44ml。수술후간장공능회복정황，술후제1천AST、ALT、TBIL화백단백변화명현，지수술후제7천기본회복지정상，표명정준간절제술대간공능영향경미。간절제술후상관성병발증발생솔위21.87%，기중주요위발생간공능쇠갈、담루、복수、흉수화폐염。소유병발증균경보수치료치유。결론정준간절제부합간장악성종류적근치성절제적원칙，가이직관현시간장혈관여간장병변적관계，최대한도적보류정상간장실질。유우이경결찰료소절제간단적입간혈류，명현감소리단간실질시적출혈，가이불조단제일간문혈류，대보류적간장실질무결혈성손상，수술후간공능손상경미，종이제고료간절제수술적안전성，명현감소료위수술기적병발증발생솔。
Objective In order to summarize the clinical application experience on precise hepatectomy for the treatment of the patients with hepatic lesions.Methods Thirty two patients with liver diseases underwent precise hepatectomy from Januray 2013 to Januray 2014.The liver function,hepatic reserve function,remnant liver volume,the relation between hepatic blood vessel distribution, hepatic bile duct distribution and hepatic tumors were evaluated to predict radical resection of hepatic malignant tumors before operation. The operative time, intraoperative blood loss, postoperative recovery of hepatic function,post-hepatectomy complications and prognosis of hepatic malignant tumors were analysed.Results All patients with hepatic lesions underwent successfully precise anatomical liver resection with a median operative time 213.91 minutes, estimated intraoperative blood loss 424.44 ml. The level of AST、ALT、TBil and albumin of the patients had obvious change in the postoperative ifrst day and the level of AST、ALT、TBil and albumin of the patients recovered in the postoperative 7th day. All patients underwent precise liver resection had slight change of the liver function. The complications rate after precise anatomical liver resection was approximately 21.87% (7 patients).The major complications rate after liver resection were hepatic failure, bile leakage, ascites, hydrothorax and pneumonia. All patients with complications after liver resection recovered by non-operative methods. Conclusions Precise hepatectomy is an effective method for the treatment of the patients with liver diseases including hepatic malignant tumors.It could visualize the relationship between liver lesions and hepatic vascular,reserve normal remnant hepatic parenchyma to the most degree,reduce intraoperative blood loss,increase operative safety and reduce complications rate after liver resection.