探讨循肝脏重要脉管精准肝切除在肝胆肿瘤治疗中的应用价值。

回顾性分析2012年1月至2013年1月在郑州大学第一附属医院行循肝脏重要脉管精准切除术治疗的26例肝胆肿瘤患者临床资料。其中男14例，女12例；年龄20～66岁，中位年龄56岁。所有患者均签署知情同意书，符合医学伦理学规定。根据术前影像学检查及术中探查结果选择紧邻肿瘤的重要脉管为解剖引导，预测切肝平面。术中超声检查明确肿瘤与门静脉分支、肝静脉、下腔静脉等肝脏重要脉管解剖位置的关系。应用超声吸引刀、双极电凝等手术器械完成精准肝切除。

26例患者均顺利完成手术，肿瘤全部完整切除。其中行左半肝+尾状叶切除7例，右半肝切除6例，肝中叶切除4例，扩大右半肝切除3例，肝Ⅳb、Ⅴ段切除2例，肝右前叶切除2例，左半肝+尾状叶切除+胰十二指肠切除1例，肝尾状叶切除+肝后下腔静脉人工血管置换1例。平均手术时间(5.5±0.4) h，术中出血量(580±59) ml，住院时间(19±3) d。术后患者无发生大出血、肝衰竭等严重并发症，术后腹腔感染2例，胆漏1例，经抗感染及引流治疗治愈。

循肝脏重要脉管精准肝切除是治疗肝胆肿瘤安全、有效的手术方法。

To investigate the application value of precise hepatectomy following important liver vessels for hepatobiliary tumors.

Clinical data of 26 patients with hepatobiliary tumors in the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2013 were analyzed retrospectively. There were 14 males and 12 females with the age ranging from 20 to 66 years old and a median of 56 years old. The informed consents of all patients were obtained and local ethical committee approval had been received. The important vessels closely adjacenting to tumors were selected as the guide line for dissection according to the preoperative imaging examinations and intraoperative exploration results and the liver resecting surface was predicted. The anatomic relations between the tumor and the important liver vessels such as portal branch, hepatic vein, inferior vena cava were defined by intraoperative ultrasound. Precise hepatectomy were performed with surgical instruments such as cavitron ultrasonic surgical aspirator, bipolar coagulator.

The operations of 26 patients were performed successfully and the tumors were resected completely, including left hemihepatectomy + caudate lobectomy (n=7), right hemihepatectomy (n=6), mesohepatectomy (n=4), extended right hemihepatectomy (n=3), segment Ⅳb, V hepatectomy (n=2), hepatic right anterior lobectomy (n=2), left hemihepatectomy + caudate lobectomy + pancreaticoduodenectomy (n=1), caudate lobectomy + artificial vessel replacement of retrohepatic inferior vena cava (n=1). The average operative time was (5.3±0.4) h, the intraoperative blood loss was (580±59) ml and the length of hospital stay was (19±3) d. No severe complications such as massive haemorrhage, liver failure were observed after operation. Abdominal infection was observed in 2 cases and biliary leakage in 1 case after operation and all were cured by anti-infection and drainage treatments.

Precise hepatectomy following the important liver vessels is a safe and effective surgical procedure for hepatobiliary tumors.