选择性肝血流阻断解剖性肝Ⅵ、Ⅶ、Ⅷ段切除术

Anatomical multiple hepatic segmentectomy by selective occlusion of hepatic inflow for the treatment of primary hepatic cancer

  • 摘要: 解剖性肝切除不但能够保证足够的无瘤切缘,而且还能最大限度地保留非肿瘤肝组织。2012年2月,海南医学院附属医院运用选择性肝血流阻断技术成功为 1例61岁 的男性多发原发性肝癌患者行解剖性肝Ⅵ、Ⅶ、 Ⅷ段 切除术。术前CT检查示肝Ⅵ、Ⅶ、Ⅷ段多发占位性病变,三维重建测算左半肝体积少于最小存活肝脏体积。为了最大限度保留剩余肝脏,拟行保留Ⅴ段的解剖性肝Ⅵ、Ⅶ、 Ⅷ段切除术。术中运用了两次Glisson蒂阻断技术,解剖出右半肝和右后叶的Glisson蒂,从而确定肝Ⅵ、Ⅶ、Ⅷ段的切除范围,完成了解剖性肝Ⅵ、Ⅶ、Ⅷ段切除。区域性的入肝血流阻断技术是减轻肝脏的缺血再灌注损伤的关键,对手术的顺利完成及患者术后恢复都至关重要。

     

    Abstract: Anatomic hepatic resection not only enables enough tumor free resection margin, but also guarantee the maximal remnant of normal liver tissue. A 61 year old male patient with hepatic cancer was admitted to the Affiliated Hospital of Hainan Medical College in February 2012. Multiple space occupying lesions were found in segment Ⅵ, Ⅶ and Ⅷ by computed tomography (CT). The results of CT volumetry analysis showed that the left hemihepatic volume was lesser than the minimal limit of survival, so anatomic hepatic segmentectomy of Ⅵ, Ⅶ and Ⅷ with preservation of segment Ⅴ was designed to guarantee the maximal remaining of normal liver tissue. Glisson′s pedicle transection was used twice to divide the right hemihepatic Glisson′s pedicle, segment Ⅵ and Ⅶ Glisson′s pedicle, respectivley, then the resection line was determined, and anatomical hepatic  segmentectomy  of Ⅵ, Ⅶ and Ⅷ was completed. With the procedures  adopted, the hepatic ischemia reperfusion injury and  hemodynamic instability were maximally reduced during operation.

     

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