Vishnevskiĭ V A, Efanov M G, Ikramov R Z, Shevchenko T V, Melekhina O V, Kozyrin I A
Khirurgiia (Mosk). 2008(9):33-40.
It still remains unclear which patients with hepatic tumors can favour anatomical segmental liver resections instead of major liver resection. Short term results of anatomical segmental liver resection are evaluated and analyzed. Ten patients underwent the anatomical segmental liver resection performed by posterior approach with taping of anterior right hepatic vein. Seven patients had liver metastases of colorectal cancer, one had primary hepatic carcinoma and two had benign lesions, anatomical segmental liver resection were performed without Pringle maneuver. There was no significant difference in blood loss, duration of the procedure, postoperative hospital stay and morbidity in comparison with the segmental liver resection performed by anterior approach. Multiple, large and deep-embedded lesions were removed completely, with tumor-free resection margins. Anatomical segmental liver resection performed by hilar glissonean approach is recommended in patients with compromised liver function "unfavourable" liver anatomy to replace major liver resection provides removal of only affected part of the liver accordingly to its true anatomical borders.
目前仍不清楚哪些肝肿瘤患者适合进行解剖性肝段切除术而非肝大部切除术。对解剖性肝段切除术的短期结果进行了评估和分析。10例患者接受了经后入路并结扎右肝前静脉的解剖性肝段切除术。7例为结直肠癌肝转移，1例为原发性肝癌，2例为良性病变，均在未进行Pringle手法的情况下进行了解剖性肝段切除术。与经前入路的肝段切除术相比，术中出血量、手术时间、术后住院时间及并发症发生率无显著差异。多个、较大且深埋的病变被完全切除，切缘无肿瘤残留。对于肝功能受损、“肝脏解剖结构不佳”的患者，建议采用肝门Glisson鞘入路进行解剖性肝段切除术以替代肝大部切除术，从而仅根据肝脏的真实解剖边界切除肝脏的受累部分。
