肝中叶切除术治疗中央区大肝癌25例临床分析

吴若林，耿小平，赵红川等.肝中叶切除术治疗中央区大肝癌25例临床分析[J].中华普通外科杂志.2013, 28(3):200-204

肝肿瘤，知识脉络， 肝切除术， 知识脉络，手术后并发症，知识脉络

吴若林，耿小平，赵红川，刘付宝，张志功，赵义军，王国斌，黄帆

安徽医科大学第一附属医院器官移植中心,合肥,230032

2013

200-204

知网,万方

目的 探讨肝中叶切除术治疗中央区大肝癌的手术安全性和近远期疗效,总结该术式的技术要点和经验.方法 回顾性分析2005年8月至2011年12月于安徽医科大学第一附属医院器官移植中心接受肝中叶切除术治疗且病理诊断为原发性肝细胞癌(肿瘤直径＞5 cm)的25例患者的临床资料及随访结果.其中男性24例,女性1例；年龄33～ 67岁,中位年龄48.8岁.应用Kaplan-Meier法计算本组患者无瘤及总体生存率.结果 25例均为原发性肝细胞癌,肿瘤直径5.0～15.0 cm,中位直径为8.1 cm;其中有7例瘤体直径超过10.0 cm,最大者为15 cm.HBsAg阳性22例,AFP升高者(≥20 μg/L) 16例.全组患者为Child-Pugh A级.术中第一肝门阻断23例,半肝血流阻断1例,未阻断肝门1例.肝门阻断时间12～ 70 min,平均30.3 min.手术失血量50～600 ml,平均为266.8 ml.手术时间135 ～358 min,平均为191.3 min.输血14例,住院时间9～37 d,平均20.2d.术中行门静脉癌栓取出术2例,术后并发症发生率为44％(11/25),无围手术期死亡病例.随访时间3 ～78个月,平均28个月,全组1、3年无瘤生存率分别为63.7％、26.7％,1、3年总体生存率分别为86.4％、38.7％.结论 肝中叶切除术用来治疗中央区大肝癌是安全可行的.该术式是中央区大肝癌,尤其是伴有肝硬化或者慢性肝炎背景的患者一种有效的外科治疗手段. Objective To analyze the safety of mesohepatectomy and long term outcomes for patients of centrally located large hepatocellular carcinoma.Methods 25 consecutive mesohepatectomies were performed for primary hepatocellular carcinoma (diameter ＞ 5 cm) from August 2005 to December 2011.There were 24 males and 1 female with average age of 44.8 (range 33 to 67) years.Recurrence-free and overall survival rates were analyzed by the Kaplan-Meier method.Results The diagnosis of primary hepatocellular carcinoma was pathologically established in all patients.The median tumour size was 8.1 (5.0-15.0) cm.Serum hepatitis B surface antigen was detected in 22 patients,the preoperative results of serum AFP level was higher than 20 μg/μl in 16 patients.Child-Pugh grade was A in all patients.During transaction,23 patients required continuous or intermittent total portal triad clamping,one patient required hemi-occlusion of the afferent blood flow extra-hepatically.The median clamping time was 30.3 (12-70) min.The median intra-operative blood loss was 266.8 (50-600) ml.The median length of operation was 191.3 (135-358) min.14 patients had blood transfusion.The median hospital stay was 20.2 (9-37) days.The overall morbidity rate was 44％ (11/25).No patient died post-operatively.25 patients were followed-up from 3 to 78 months (average 28 months),the recurrence-free and overall 1,3year's survival rates were 63.7％,26.7％ and 86.4％,38.7％ respectively.Conclusions Mesohepatectomy is a feasible and effective surgical treatment for centrally located large hepatocellular carcinoma,especially for patients with chronic hepatitis or cirrhosis.