擴大肝葉切除以治療肝腫瘤

Extended hepatic Lobectomy for Treatment of Liver Tumor

柯成國(Chen-Guo Ker) ； 李金德(King-Teh Lee) ； 謝建勳(Jan-Sing Hsieh) ； 黃宗人(Tsung-Jen Huang) ； 沈柏青(Pai-Ching Sheen)

《The Kaohsiung Journal of Medical Sciences》 1卷5期 (1985/05) Pp. 289-296

https://doi.org/10.6452/KJMS.198505.0289

摘要

多葉性肝切除之應用因肝臟解剖學，影像診斷及麻醉學的進步，使用本術式也漸漸增多，而擴大肝葉切除術乃指擴大肝右葉切除及擴大肝左葉切除，擴大肝右葉切除為指切除肝右葉及左葉之內側分葉，而擴大肝左葉切除為切除肝左葉及行右葉之前側分葉之謂。因為這是一種較大的切除，其切除之條件宜比一般肝切除較為嚴格。
本院近三年來擴大肝葉切除者有八例，擴大右葉切除有六例，擴大左葉切除有二例，包括原發性肝癌六例，轉移性肝癌有一例及巨大血管腫瘤一例，本術式之血量在810至2500ml之間，平均為1750 ml。切除標本重量右葉六例為1130至1820公克（平均1440公克），左葉二例為830公克及700公克。手術死亡一例佔12.5%。術後追蹤原發性肝癌有兩例分別於術後30個月及7個月死亡，生存者有三例分別於術後14、10及4個月者，轉移肝癌例切除後16個月死亡，巨大血管腫瘤者街後26個月尚好。手術合併症有一例發生暫時性膽汁瘻管。
本擴大肝葉切除術之死亡率及困難性與一般肝左或右葉切除相近，所以在有適應性肝腫瘤可以考應本術式來治療，期能改善肝癌之治療成績。

並列摘要

Hepatic lobe resection has been popularly accepted as a choice of treatment of liver tumor due to well establishment of anatomy, image diagnosis of the liver and great improvement of anesthesiology. The procedure of extended hepatic lobectomy includes both extended right lobectomy and extended left lobectomy. Extended right lobectomy means resection of the whole right lobe and median segment of left lobe. Extended left lobectomy means resection of the whole left lobe and anterior segment of right lobe. The indications of extended hepatic lobectomy should be more restricted than that of ordinary hepatic lobectomy.
Eight patients of liver tumor were encountered in this operation in recent three years including extended right lobectomy in 6 cases and extended left lobectomy in 2 cases. The indications of this operation included huge hepatocellular carcinoma 6 cases, metastatic liver cancer 1 case, and giant hemangioma 1 case. The blood loss ranged from 810 to 2500 ml, with an average of 1750 ml. The weight of resected specimen ranged from 1130 to 1820 grams, with the average of 1440 grams, for right resection. It was 830 grams and 700 grams respectively for left resection.
Operative death occured in one case, with a mortality rate of 12.5%. Postoperative follow-up study for hepatocellular carcinoma revealed 3 patients are still alive in 14th, 10th, 4th post-operative month and another two died in 30th and 7th post-operative month. One patient of metastatic liver cancer died in the 16th post-operative month and the other patient of giant hemangioma is still in good condition in the 26th post-operative month. The mortality and morbidity rates were similiar between extended hepatic lobectomy and ordinary hepatic lobectomy. Therefore, it is worthy to perform this procedure in case of huge primary or metastatic liver tumors.

並列關鍵字

live tumors ； hepatocellular carcinoma ； extended hepatic lobectomy