探讨精准肝脏分离技术在复杂肝脏切除术中的应用价值。

回顾性分析2003年2月至2009年6月在北京大学人民医院接受复杂肝脏切除术的60例患者的临床资料，其中活体肝移植供体右半肝切除13例、肝脏恶性肿瘤37例、肝脏巨大海绵状血管瘤10例，所有患者均签署知情同意书，符合医学伦理学规定。术前和（或）术中应用影像学诊断技术，术中应用螺旋水刀和超声吸引刀（CUSA）进行精准肝脏分离技术，行右半肝切除13例、肝右三叶切除8例、肝右后叶（Ⅵ段+Ⅶ段）切除19例、肝中叶（Ⅳ段+Ⅴ段+Ⅷ段）切除9例、肝脏Ⅷ段切除5例、肝尾状叶切除6例。记录术中出血量、手术时间等，观察术后丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、白蛋白（ALB）、凝血酶原时间（PT）、总胆红素（TB）和直接胆红素（DB）等肝功能指标变化及术后并发症发生情况，肝切除手术前后肝功能指标比较采用秩和检验。

平均手术时间370 min，术中平均出血量955 ml，输血量超过400 ml者13例（22%），ALT、AST、DB在术后7 d恢复至正常范围，ALB、TB术后5 d恢复至正常范围。术后平均住院时间11.7 d。术后并发症包括腹水6例、胸腔积液5例、肺不张2例、肺部感染4例，无发生严重并发症及手术死亡病例。

在复杂肝脏手术中应用精准肝脏分离技术，出血量可控，术后无严重并发症，肝功能恢复顺利，具有一定实用价值。

To evaluate the application of precise liver dissection technique in complex hepatectomy.

Sixty cases of complex hepatectomy from Feburary 2003 to June 2009 were analyzed retrospectively, which included 13 cases of donor right hepatic lobes harvested in living donor liver transplantation (LDLT), 37 cases of liver malignant tumor and 10 cases of hepatic giant cavernous hemangioma. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. Helix hydro-jet and cavitron ultrasonic surgical aspirator (CUSA) were applied with the assistance of precise radiographic techninque before and/or during the operation. Among these patients, right hepatic resection was performed in 13 cases, right hepatic trisegmentectomy in 8 cases, hepatic segment Ⅵ+Ⅶ resection in 19 cases, segment Ⅳ+Ⅴ+Ⅷ resection in 9 cases, segment Ⅷ resection in 5 cases and caudate lobe resection in 6 cases. The intraoperative blood loss, operation time, postoperative hepatic function such as alanine aminotransferase(ALT), aspartate aminotransferase(AST), albumin(ALB), prothrombin time(PT), total bilirubin(TB), direct bilirubin(DB) and complications in these patients were recorded.

The average operation time was 370 min and average intraoperative blood loss was 955 ml. Thirteen out of 60 patients (22%) received heterologous packed red blood cell (PRBC) transfusion for more than 2 units per case. ALT, AST and DB recovered normal in 7 days after operation and ALB, TB recovered normal in 5 days after operation. The average length of stay in hospital was 11.7 days. Post-operative complications included ascites in 6 cases, hydrothorax in 5 cases, atelectasis in 2 cases and pulmonary infection in 4 cases. No severe complications and death occurred in this group.

Precise liver dissection is useful in complex hepatectomy. There is not massive blood loss during operation nor sereve complications after operation and the liver funtion recovery is good.