Botea Florin, Ionescu Mihnea, Braşoveanu Vladislav, Hrehoreţ Doina, Alexandrescu Sorin, Grigorie Mihai, Stanciulea Oana, Nicolaescu Diana, Tomescu Dana, Droc Gabriela, Ungureanu Daniela, Fota Ruxandra, Croitoru Adina, Gheorghe Liana, Gheorghe Cristian, Lupescu Ioana, Grasu Mugur, Boroş Mirela, Dumitru Radu, Toma Mihai, Herlea Vlad, Popescu Irinel
Chirurgia (Bucur). 2017 May-Jun;112(3):259-277. doi: 10.21614/chirurgia.112.3.259.
Liver resection (LR) is the treatment of choice for most benign and malignant focal liver lesions, as well as in selected patients with liver trauma. Few other therapies can compete with LR in selected cases, such as liver transplantation in hepatocellular carcinoma (HCC) and ablative therapies in small HCCs or liver metastases. The present paper analyses a single center experience in LR, reviewing the indications of LR, the operative techniques and their short-term results.
Between January 2000 and December 2016, in "Dan Setlacec" Center of General Surgery and Liver Transplantation were performed 3165 LRs in 3016 patients, for pathologic conditions of the liver. In the present series, liver resections for living-donor liver transplantation were excluded. The median age of the patients was 56 years (mean 58 years; range 1-88), with male/female ratio 1524/1492 and adult/pediatric patient ratio 2973/43. Malignant lesions were the main indication for LR (2372 LRs; 74.9%). Among these, colorectal liver metastases were the most frequent indication (952 LRs; 30.1%), followed by hepatocellular carcinoma (575 patients, 18.2%). The highest number of resected tumors per patient was 21, and the median diameter of the largest tumor was 40 mm (mean 51 mm; range 3-250). Major resections rate was 18.6% (588 LRs) and anatomical LRs were performed in 789 patients (24.9%). The median operative time was 180 minutes (mean 204 minutes; range 45-920). The median blood loss was 500 ml (mean 850 ml; range 500-9500), with a transfusion rate of 41.6% (1316 LRs). The morbidity rate was 40.1% (1270 LRs) and the rate of major complications (Dindo-Clavien IIIa or more) was 13.2% (418 LRs). Mortality rate was 4.2% (127 pts).
LRs should be performed in specialized high-volume centers to achieve the best results (low morbidity and mortality rates).
肝切除术（LR）是大多数良性和恶性肝脏局灶性病变以及部分肝外伤患者的首选治疗方法。在某些特定情况下，很少有其他治疗方法能与肝切除术相媲美，例如肝细胞癌（HCC）的肝移植以及小肝癌或肝转移瘤的消融治疗。本文分析了一个单中心的肝切除术经验，回顾了肝切除术的适应证、手术技术及其短期结果。
2000年1月至2016年12月期间，在“丹·塞特拉塞克”普通外科和肝移植中心，对3016例患者进行了3165例肝切除术，以治疗肝脏疾病。在本系列研究中，排除了活体肝移植的肝切除术。患者的中位年龄为56岁（平均58岁；范围1 - 88岁），男女比例为1524/1492，成人/儿童患者比例为2973/43。恶性病变是肝切除术的主要适应证（2372例肝切除术；74.9%）。其中，结直肠癌肝转移是最常见的适应证（952例肝切除术；30.1%），其次是肝细胞癌（575例患者，18.2%）。每位患者切除肿瘤的最多数量为21个，最大肿瘤的中位直径为40毫米（平均51毫米；范围3 - 250毫米）。大手术率为18.6%（588例肝切除术），789例患者（24.9%）进行了解剖性肝切除术。中位手术时间为180分钟（平均204分钟；范围45 - 920分钟）。中位失血量为500毫升（平均850毫升；范围500 - 9500毫升），输血率为41.6%（1316例肝切除术）。发病率为40.
