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目的 探讨无血切肝术在治疗常规手术方法难以切除的肝脏原发性恶性肿瘤中的价值。方法 选择有肝切除手术适应证而以常规手术方法不能切除 ,或外院已作剖腹手术未能切除的肝脏原发性恶性肿瘤 ,加施无血切肝技术进行治疗 6 8例资料进行总结分析。结果 6 8例均完成无血切肝术 ,其中经腹常温下全肝血流阻断切肝术 6 6例 ,经胸腹联合切口常温下全肝血流阻断切肝术 +右肺下段转移癌切除术 2例。施行右三叶肝切除 3例 ,左三叶肝切除术 2例 ,右半肝切除 13例 ,左半肝切除术 12例 ,肝中叶切除术 6例 ,肝尾叶切除术 5例 ,联合肝段切除术 2 8例。附加下腔静脉壁部分切除 ,修补术 12例 ,门静脉癌栓摘除术 16例 ,主肝静癌栓摘除术 2例 ,下腔静脉癌栓摘除术 1例。术中阻断全肝血流的时间最长 2 6 min,最短 4分钟 ,平均 12 .2 min± 5 .9min,超过 2 0分钟者仅 2例 ,分别为 2 3min,2 6 min。术中连续监测 HR、SAP、DAR、MAP、CVP及尿量 ,均平稳。术后监测 AL P、L DH、r- GT、BUN、Cr均正常 ,AL T均有不同程度升高 ,护肝治疗 7～ 10天恢复正常。病理诊断 :原发性肝癌 (PL C) 6 1例 ,肝母细胞瘤 5例 (均为小儿 ) ,肝脏血管内皮肉瘤 1例 ,原发性肝脏恶性淋巴瘤 1例。全组顺利康复 6 6例 ,死亡 2例 ,手术死亡率 2 .9%。
Objective To investigate the value of non-hepatectomy in the treatment of primary malignant tumors of the liver that is difficult to remove by conventional surgical methods. Methods The indications of liver resection were selected and the cases were not resected by conventional surgical methods. The data of 68 cases with unresectable hepatic primary malignant tumors who underwent laparotomy by hepatectomy were analyzed retrospectively. Results Sixty-six patients underwent transhepatic revascularization without hepatectomy. Among them, transhepatic transurethral ablation of transhepatic blood flow was performed in 66 cases, and the transhepatic-hepatectomy hepatectomy Metastatic cancer resection in 2 cases. 3 cases of right trilobate hepatectomy, 2 cases of left trilobate hepatectomy, 13 cases of right hepatectomy, 12 cases of left hepatectomy, 6 cases of middle hepatectomy, 5 cases of hepatectomy, Segment resection 28 cases. Additional partial resection of the inferior vena cava wall, repair in 12 cases, 16 cases of portal vein tumor thrombectomy, primary hepatic tumor resection in 2 cases, 1 case of inferior vena cava tumor excision. The intraoperative blocking of the longest hepatic blood flow was 26 min, the shortest 4 min, mean 12.2 min ± 5.9 min, and only 2 patients were over 20 min, which were respectively 23 min and 26 min. Intraoperative continuous monitoring of HR, SAP, DAR, MAP, CVP and urine output, were stable. Postoperative ALP, L DH, r-GT, BUN, Cr were normal, ALT were increased to varying degrees, liver protection 7 to 10 days returned to normal. Pathological diagnosis: 61 cases of primary liver cancer (PL C), 5 cases of hepatoblastoma (both children), liver angioelastoma in 1 case, 1 case of primary liver malignant lymphoma. The whole group successfully recovered 6 6 cases, 2 died, the operative mortality rate was 2.9%.