目的探讨经肝正中裂路径行单独完整尾状叶全切除治疗肝尾状叶肿瘤的策略。方法回顾性分析1995年1月至2006年6月,接受经正中入路单独完整尾状叶切除术的19例直径4～12 cm 的肝尾状叶肿瘤患者的临床资料。术中常规使用两套彭氏多功能手术解剖器使用技术、低中心静脉压技术、选择性应用肝脏血流控制技术、绕肝提拉技术、逆行肝尾状叶切除技术等。19例中肝细胞性肝癌13例、胆管细胞性肝癌4例、肝血管瘤2例。结果所有于术均顺利完成。于术平均时间(296±55)min,术中失血量500～3000 ml,平均1200 ml。全组无围手术期(术后30 d 内)死亡病例,术后发生腹水2例,经输注白蛋白、利尿后治愈;右胸腔积液5例,经多次穿刺抽液后治愈;胆漏2例,分别引流10 d 和13 d 后自愈。结论经肝正中裂路径可提高肝尾状叶肿瘤的手术切除率;而常规应用两套彭氏多功能手术解剖器使用技术、低中心静脉压技术、选择性应用肝脏血流控制技术、绕肝提拉技术、逆行肝尾状叶切除技术等技术是安全实施经正中入路单独完整尾状叶切除术的主要策略。
Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.
