Franco D, Smadja C, Meakins J L, Wu A, Berthoux L, Grange D
Department of Research on Surgery of the Liver and Portal Hypertension, Hôpital Paul Brousse, Villejuif, France.
Arch Surg. 1989 Sep;124(9):1033-7. doi: 10.1001/archsurg.1989.01410090039008.
Liver resection for a neoplasm was performed in 100 patients between 1979 and 1987. There were 43 hepatocellular carcinomas (70% of them arising in patients with cirrhosis), 28 metastases from colorectal cancers, 20 benign tumors, and 9 miscellaneous tumors. Forty-nine patients had a major liver resection, 36 a segmentectomy, and 15 a nonanatomic liver resection. Great care was taken to avoid intraoperative and postoperative bleeding, including late ligation of the hepatic vein, the use of Kelly fracture and resorbable clips for hemostasis of transection planes in 74 patients, and temporary clamping of the portal pedicle in 22. Drainage of the abdomen was avoided in 21 patients to prevent ascitic leakage to decrease the postoperative hospital stay. Operative mortality was 1%. There were eight major complications, including one bile leak, one subphrenic abscess, and three subphrenic hematomas. The use of resorbable clips significantly reduced operative time and transfusion requirements. In patients with cirrhosis, temporary clamping of the hepatic pedicle significantly decreased blood loss. Avoiding drainage significantly decreased the postoperative hospital stay.
1979年至1987年间，对100例患者实施了肝脏肿瘤切除术。其中有43例肝细胞癌（70%发生于肝硬化患者），28例结直肠癌转移瘤，20例良性肿瘤，9例其他肿瘤。49例患者接受了大范围肝切除术，36例接受了肝段切除术，15例接受了解剖外肝脏切除术。术中及术后均十分注意避免出血，包括74例患者晚期结扎肝静脉、使用凯利夹及可吸收夹对肝断面止血，22例患者临时阻断肝门蒂。21例患者未行腹腔引流以防止腹水漏出，从而缩短术后住院时间。手术死亡率为1%。出现了8例严重并发症，包括1例胆漏、1例膈下脓肿和3例膈下血肿。使用可吸收夹显著缩短了手术时间并减少了输血量。对于肝硬化患者，临时阻断肝门蒂显著减少了失血量。避免引流显著缩短了术后住院时间。
