探讨肝Ⅷ段大肝癌手术切除治疗的安全性和疗效。

回顾性分析2008年1月至2012年12月在东方肝胆外科医院行肝Ⅷ段大肝癌切除的17例患者临床资料。其中男15例，女2例；年龄30~62岁，中位年龄49岁。患者均签署知情同意书，符合医学伦理学规定。术中采用低中心静脉压，合理应用各种血流阻断法，控制肝静脉和下腔静脉大出血，以完整切除肿瘤为原则。生存分析采用Kaplan-Meier法和Log-rank检验。

17例患者均顺利完成手术，手术时间中位数133（80~190）min，术中出血量150（50~800）ml。输血3例，分别输血600、800、600 ml。无围手术期死亡。术后9例出现并发症，其中胸腔积液7例，肺不张1例，腹腔积液+胸腔积液1例，无术中大出血、空气栓塞等严重并发症发生。16例术后行辅助性TACE治疗。患者无瘤生存时间12（1~116）个月，总体生存时间30（12~116）个月；1、3、5年无瘤生存率分别为58.8%、40.3%、30.3%，1、3、5年总体生存率分别为100.0%、48.1%、41.3%。

肝切除仍是肝Ⅷ段大肝癌首选治疗方案，手术以完整切除肿瘤为主要目标，可获得良好疗效。术中采用多种措施控制出血，保护主要管道结构，避免损伤肝静脉和下腔静脉，预防空气栓塞，妥善处理好肝脏创面，可保证手术安全。

To evaluate the safety and clinical efficacy of surgical resection in patients with large liver cancer in segment Ⅷ.

Clinical data of 17 patients who underwent resection of segment Ⅷ large liver cancer from January 2008 to December 2012 in Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. Among them, 15 patients were male and 2 female, aged 30-62 years, witha median age of 49 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Intraoperatively, low central venous pressure was adopted, and different vascular occlusions were reasonably applied to control the massive hemorrhage of the hepatic vein and inferior vena cava. Radical resection of the tumor was the principle of operation. Survival analysis were conducted with Kaplan-Meier method and Log-rank test.

All 17 patients underwent the operation successfully. The median operation time was 133 (80-190) min. Intraoperative blood loss was 150 (50-800) ml. Blood transfusion was performed in 3 cases (600, 800 and 600 ml). No perioperative death occurred. Postoperative complications were noted in 9 cases, including pleural effusion in 7 cases, atelectasis in 1 and peritoneal effusion combined with pleural effusion in 1. No serious complications, such as intraoperative hemorrhage and air embolism, were observed. Adjuvant TACE was performed in 16 cases after operation. The tumor-free survival time was 12 (1-116) months and the overall survival time was 30 (12-116) months. The 1-, 3-, and 5-year tumor-free survival rates were 58.8%, 40.3% and 30.3%, respectively. The 1-, 3-, and 5-year overall survival rates were 100.0%, 48.1% and 41.3%, respectively.

Hepatectomy is still the primary choice for the treatment of large liver cancer in segment Ⅷ. The main objective of operation is radical resection of tumors, which yields good clinical efficacy. Intraoperatively, hemorrhage control with different measures, to protect the main vascular structures, to avoid the hepatic vein and inferior vena cava damage, to prevent the incidence of air embolism and to properly manage the liver section, can ensure the safety of operation.