术中超声在亚肝段为主的肝切除治疗肝癌合并门静脉高压症中的应用价值

摘要

目的 探讨术中超声在亚肝段为主的肝切除治疗原发性肝癌(primary liver cancer,PLC,简称肝癌)合并门静脉高压症(portal hypertension,PHT)的应用价值.方法 PLC合并PHT患者27例,首先在术中超声引导下行亚肝段染色,随后使用电刀沿肝脏表面染色区域标记切离线,最后完成亚肝段为主精准切除,术后肝离断面显露肝静脉的侧壁及亚肝段的Glisson根部残端.结果 27例患者均行亚肝段为主的精准肝切除术,平均手术时间(180±66)分钟,手术出血量为(455±325)ml,术后并发症发生率为30.0%,术后住院时间为(16±3)天,手术后1年复发率22.0%,1年生存率93.0%.结论 在术中超声引导下,采用亚肝段为主的精准肝切除,确保剩余肝脏解剖结构完整和代偿功能最大化,具有较好的近期预后.%Objective To investigate the clinical value of intraoperative ultrasonography in treatment of hepatocellular carcinoma with portal hypertension mainly with subsegmentectomy.Methods The clinical data of 27 patients with hepatocellular carcinoma patients with portal hypertension treated by mainly with subsegmentectomy under intraoperative ultrasonography guidance were retrospectively analyzed.First subsegment portal vein branches were stained with methylene blue under intraoperative ultrasonography guidance,and then stained area was marked with an electric cautery,after precise subsegmentectomy,the corresponding hepatic vein wall,as well as stumps of subsegment portal venous branches were exposed on the raw surface of the liver,stump of k of the middle and right hepatic ven.Resuts 27 patients were performed mainly with subsegmentectomy.Mean operation time,The mean volume of blood loss,incidence of postoperative complications,postoperative hospital stay,1-year tumor recurrence rate and 1-year tumor survival were(180±66)minutes,(455±325)ml,30%(8/27),(16±3)days,22%(6/27)and 93%(25/27),respectively.Conclusion Using the precise hepatectomy mainly with subsegmentectomy under intraoperative ultrasonography guidance could ensure the residual liver anatomical structure integrity and maximize the compensatory function with a good recent prognosis.