经肝右静脉离断并重建入路肝尾状叶肿瘤切除术.PDFVIP

460 2018 12 7 6 Chin J Hepat Surg(Electronic Edition), December 2018, Vol. 7, No. 6 中华肝脏外科手术学电子杂志 年 月第 卷第 期 临床研究 经肝右静脉离断并重建入路肝尾状叶 肿瘤切除术 杨雪 石磊 李起 郭健 吕毅 耿智敏 摘要 目的 探讨经肝右静脉离断并重建入路肝尾状叶肿瘤切除术安全性和疗效。方法 【 】 回顾性分析2017 年 11 月西安交通大学第一附属医院1 例肝尾状叶肿瘤切除术患者临床资料。患者女， 54 岁，术前诊断为肝尾状叶肝细胞癌。患者签署患者知情同意书，符合医学伦理学规定。采用新创的经 肝右静脉离断并重建入路法实施肝尾状叶肿瘤切除术，优先处理肝短静脉，离断肝右静脉后切除尾状叶 肿瘤，再重建肝右静脉。结果 手术顺利，术中阻断右半肝血流及肝下下腔静脉20 min ，全肝血流阻断 1 次，时间 15 min，术中出血量800 ml ，输红细胞4 U 。术后常规给予抗感染、抑酸、降低门静脉压力、护 肝、营养支持治疗。术后7 d 复查上腹部CT 示肝右叶近肝门处斑片状低密度影，门静脉不宽，肝内胆管 无扩张，胆囊窝少量积气积液。病理学检查结果示肝块状型中分化肝细胞癌伴局部囊性变。术后 15 d 恢复顺利出院。结论 与其他尾状叶手术方式相比，经肝右静脉离断并重建入路肝尾状叶肿瘤切除术 创伤更小、出血量更少，是一种新的尾状叶切除入路，适用于累及腔静脉及尾状突的尾状叶肿瘤切除。 关键词 肝肿瘤； 肝切除术； 肝右静脉 【 】 Resection of caudate lobe tumor via devascularization and reconstruction of right hepatic vein Yang Xue, Shi Lei, Li Qi, Guo Jian, Lyu Yi, Geng Zhimin. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xian Jiaotong University, Xian 710061, China Corresponding author: Geng Zhimin, Email: gengzhimin@mail.xjtu.edu.cn Abstract Objective To evaluate the safety and clinical efficacy of resection of caudate lobe 【 】 tumor via devascularization and reconstruction of right hepatic vein. Methods Clinical data of a patient who underwent resection of caudate lobe tumor in the First Affiliated Hospital of Xian Jiaotong University in November 2017 were retrospectively analyzed. The patient was female, 54-year-old, was diagnosed with hepatocellular carcinoma in the liver caudate lobe before operation. The informed consent of the patient was obtained and the local ethical committee approval was received. Resection of caudate lobe tumor was performed via a new approach, devascularization and reconstruction of