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目的 探讨肝脏 2cm以下实质性微小占位的手术定位及切除。方法 1986～ 2 0 0 0年经影像学检查发现、病理确诊的直径≤ 2cm肝脏实质性小占位病变 2 7例 ,共 34个病灶。结果 术中看见肿瘤侵犯肝包膜 6个病灶 ;术中可扪及 13个病灶 ;均行肝局部切除术。未触及 15个病灶分别根据术前影像学定位下行肿瘤局部切除 4个 ,肝段或半肝切除 5个 ;术中B超定位下切除 4个 ;手术原疤痕定位肿瘤局部切除 2个。结论 熟悉肝脏的解剖及多种影像学检查是肿瘤定位的基础。术中的全肝扪诊 ,可避免病灶的遗漏 ;对不能触及的小病灶 ,可根据术前影像学定位下切除或行术中B超检查或肝包膜切开探查 ,切除病灶。
Objective To investigate the surgical localization and resection of subtotal mass below 2 cm in liver. Methods From 1986 to 2000, it was found by imaging examination that pathologically confirmed small lesions of 27% of the liver with a diameter of ≤ 2 cm were totally 34 lesions. Results Intraoperative tumor invasion of 6 lesions of hepatic capsule was observed; intraoperative palpable and thirteen lesions were performed; local hepatectomy was performed. According to the preoperative imaging location, there were 4 local tumor resection and 5 liver segment or hemihepatectomy, respectively. There were 4 resections under B ultrasound and 2 tumor resection. Conclusion Familiar with liver anatomy and multiple imaging examination is the basis of tumor localization. Intraoperative palpation of the whole liver can avoid the omission of the lesion; can not be touched on the lesion, according to the preoperative imaging or resection under the operation of B-ultrasound or liver capsule resection exploration, removal of the lesion.