【摘要】 目的小儿巨大肝肿瘤切除术中,常规行肝门阻断,本研究对不阻断肝门行巨大肝肿瘤切除术进行探讨。方法从2001年7月至2004年12月,我院对16例患儿施行不阻断肝门巨大肝肿瘤切除术,患儿年龄28d~14岁,平均3.4岁。其中男12例,女4例,肿瘤直径11~23cm,平均14.6cm,其中右半肝和左外叶内分别有一肿块1例。肝母细胞瘤9例,肝错构瘤4例,肝血管瘤3例。结果本组16例患儿手术全部成功,不阻断肝门行右半肝(Ⅴ~Ⅷ)切除8例,右三叶切除4例,左三叶切除1例,左半肝切除1例,第二肝门及右下叶肝段切除各1例。患儿术中无死亡,血流动力学指标稳定。本组良性巨大肝肿瘤患儿术后随访7个月~3.5年,目前均健康生存,无肿瘤复发,生长发育正常;肝母细胞瘤9例患儿术后常规化疗,患儿已经随访6~45个月,目前无瘤生存8例,2年以上4例,肝功能正常,正常生活。另外1例左外叶和右叶同时发现肝母细胞瘤,手术分别切除后5个月脑肺转移,于术后7个月死亡。结论不阻断肝门巨大肝肿瘤切除术,是一种安全可行的手术。术者熟练的肝脏解剖知识和肝切除技术、紧密结合术前和术中影像学技术了解肿瘤与大血管关系、彻底结扎肿瘤侧入肝肝动脉和门静脉及肝左右静脉共干或肝右静脉,是手术成功的关键。更多还原

【Abstract】 Objective To investigate the results of resection of huge liver tumor without using vascular exclusion maneuver.Methods Sixteen children with huge liver tumor underwent hepatectomy without hepatic vascular exclusion in our hospital.Their age ranged from 28d to 14years.The diameter of the tumor was from 11 to 23cm.In these patients,9 were hepatoblastoma,4 with hamartoma and the other 3 with hemangioendothelioma.Results Resection of the liver tumor without the vascular exclusion was successfully accomplished in all patients.Right hemihepatectomy(segments V to VIII) was undertaken in 8 cases,right trihepatectomy(segments I,IV,V to VIII) in 4,and left trihepatectomy(segments I to V and VIII),left hemihepatectomy,segment IV,VII and VIII and segment V and VI resections in each one respectively.During the follow-up(6 to 45 months),15 patients survived without tumor recurrence.The other one patient with two tumors in right and left lobes died of brain and lung metastasis at 7 months after operation.Conclusions Resection of tumor without vascular exclusion is an effective,safe and feasible operation for children with huge liver tumor.更多还原