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目的总结复杂巨大肝肿瘤的精确切除经验。方法 2008年4月至2009年8月期间四川大学华西医院肝胆胰外科行复杂巨大肝肿瘤精准切除52例,术前仔细进行肝脏储备功能、肝脏影像学等评估,术中选择适当的手术入路、血流阻断方式、断肝新技术、结合术中B超等方法。结果本组病例平均手术时间为350 min(210~440 min),半肝血流阻断时间平均为43 min(8~57 min),术中平均出血量为370 ml(250~1 150 ml),谷丙转氨酶恢复正常平均时间为10 d(7~14 d),总胆红素恢复正常平均时间为4.5 d(3~10 d);术后并发症发生率低,仅6例出现轻度漏胆,无肝功能衰竭等重大并发症,无死亡病例。结论精准肝切除治疗复杂巨大肝肿瘤安全、可行。
Objective To summarize the precise resection experience of complex giant liver tumors. Methods From April 2008 to August 2009, 52 patients with complicated giant hepatic tumor resected in hepatobiliary and pancreatic surgery department of West China Hospital of Sichuan University were carefully resected. Liver reserve and liver imaging were evaluated preoperatively. The appropriate surgical approach , Blood flow blocking method, breaking new liver technology, combined with intraoperative B-method. Results The mean operative time was 350 min (210-440 min) in this group of patients. The average time of partial hepatic occlusion was 43 min (range, 8-57 min). The mean intraoperative blood loss was 370 mL (250-1 150 mL) , Alanine aminotransferase return to normal average time was 10 d (7 ~ 14 d), total bilirubin return to normal average time was 4.5 d (3 ~ 10 d); postoperative complications were low, only 6 patients with mild Dilate, no liver failure and other major complications, no deaths. Conclusions Precision hepatectomy is safe and feasible for the treatment of complex giant liver tumors.