Yuan Miaoxian,Yin Qiang,Liu Chaoyang.Experience of mesohepatectomy in the treatment of hepatic tumors in children[J].Journal of Clinical Pediatric Surgery,2019,18(10):859-863.[doi:10.3969/j.issn.1671-6353.2019.10.012]
肝脏中叶切除术治疗小儿肝脏肿瘤的疗效与安全性分析
- Title:
- Experience of mesohepatectomy in the treatment of hepatic tumors in children
- Keywords:
- Liver Neoplasms; Central Hepatic Resection; Treatment Outcome; Child
- 分类号:
- R726.1;R73;R735.7
- 摘要:
- 目的 探讨肝脏中叶切除术治疗小儿肝脏肿瘤的安全性及临床疗效。方法 回顾性分析2017年6月至2019年5月由湖南省儿童医院收治的4例肝脏肿瘤行肝中叶切除术患儿的临床资料。其中男童2例，女童2例；年龄4~24个月，中位年龄11.25个月。完善腹部CT、MRI及肝脏三维成像检查后，均行肝中叶切除术。结果 所有患儿顺利实施肝中叶切除术，手术时间分别为300 min、240 min、250 min和240 min，术中出血量分别为600 mL、150 mL、400 mL和250 mL，术中均有输血，输血量分别为浓缩红细胞320 mL、240 mL、400 mL、320 mL，血浆分别为200 mL、150 mL、150 mL和150 mL。术后病理诊断分别为间叶性错构瘤、上皮型-胎儿型肝母细胞瘤、混合上皮间叶型肝母细胞瘤和胎儿型肝母细胞瘤。术后1例发生胆漏，经充分引流等保守治疗后治愈；无一例发生围手术期死亡。随访时间5~18个月，随访期间无一例肿瘤复发。结论 完善术前相关检查以及肝脏肿瘤的三维成像，且熟练掌握Glission鞘分离的技巧，精准把控手术切除平面，可实现解剖性精准肝中叶切除；肝中叶切除术治疗小儿肝脏肿瘤是安全、有效的。
- Abstract:
- Objective To explore the safety and efficacy of mesohepatectomy for heaptic tumors in children.Methods The clinical data were analyzed retrospectively for 4 children of heaptic tumors from June 2017 to May 2019.There were 2 boys and 2 girls with a median age of 11.25(4-24) months.The examinations included computed tomography (CT),magnetic resonance imaging (MRI) and three-dimensional hepatic imaging.Results All patients underwent mesohepatectomy.The operative durations were 300,240,250 and 240 min; volumes of intraoperative blood loss 600,150,400 and 250 ml; volumes of condensed erythrocyte transfusion 320,240,400 and 320 ml; volumes of transfused plasma 200,150,150 and 150 ml respectively.The postoperative pathological diagnoses were mesenchymal hamartoma,epithelial-fetal type hepatoblastoma,mixed epithelian-mesenchymal hepatoblastoma and fetal type hepatoblastoma. One case of postoperative bile leakage was cured after a thorough irrigation.No perioperative mortality occurred.During a follow-up time period of 5-18 months,there was no recurrence of tumor.Conclusion Precise anatomical hepatectomy may be achieved by accurate evaluations,proficient skills of Glissonean transection and precise defining cutting surface.Mesohepatectomy is both safe and effective in children.
参考文献/References:
1 Aronson DC,Meyers RL.Malignant tumors of the liver in children[J].Semin Pediatr Surg,2016,25(5):265-275.DOI:10.1053/j.Sempedsurg.2016.09.002.2.
2 Wei AC,Tung-Ping Poon R,Fan ST,et al.Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma[J]Br J Surg,2003,90(1):33-41.
3 Melendez J,Ferri E,Zwillman M,et al.Extended hepatic resection:a 6-year retrospective study of risk factors for perioperative mortality[J].J Am Coil Surg,2001,192(1):47-53.
4 Chen XP,Qiu FZ,Lau WY,et al.Mesohepatectomy for hepatocellular carcinoma:a study of 256 patients[J].Int J Colorectal Dis,2008,23(5):543-546.
5 Cheng CH,Yu MC,Wu TH,et al.Surgical resection of centrally located large hepatocellular carcinoma[J].Chang Gung Med J,2012; 35(2):178-191.
6 Kawaguchi Y HondaG,Endo I,et al.Current Technical Issues for Surgery of Primary Liver Cancer[J].Liver Cancer,2016,6(1):51-58.DOI:10.1159/000449345.
7 乔国梁,李龙,葛军涛等.累及第二、三肝门巨大肝母细胞瘤手术切除41例[J].临床小儿外科杂志,2014,13(2):99-102.DOI:10.3969/j.Issn.1671-6553.2014.02.004. Qiao GL,Li L,Ge JT,et al.Surgical resection of huge hepatoblastoma involving the second and third hepatic hilums[J].J Clin Ped Sur,2014,13(2):99-102.DO1:10.3969/j.issn.1671-6553.2014.02.004.
8 Fromer MW,Gaughan JP,Atabek UM,et al.Primary malignancyisan independent determinant of morbidity and mortality after liver resection[J].Am Surg,2017,83(5):436-444.
9 Fang CH,Chen QS,Fang C,et al.Efficacy of three dimensional visualization technique assisted hepatectomy for the treatment of primary liver cancer[J].Chin J Surg,2015,53(8):574-579.
10 李鹏鹏,王志恒,黄罡,等.肝脏三维可视化技术在肝脏恶性肿瘤治疗规划中的应用研究[J].中华外科杂志,2017,55(12):916-922.DOI:10.3760/cma.j.issn.0529-5815.2017.12.008. Li PP,Wang ZH,Huang G,et al.Application of liver three-dimensional visualization technologies in the treatment planning of hepatic malignant tumor[J]. Chin J Surg,2017,55(12):916-922.DOI:10.3760/cma.j.issn.0529-5815.2017.12.008.
11 Togo S,Shizawa R,Kanemura E,et al.Usefulness of 3-dimensional computed tomography for caudate lobectomy by transhepatic anterior approach[J].Hepatogastroenterology,2002,49(44):461-466.
12 袁荣发,闵家祺,邬林泉,等.3D技术在中央型肝肿瘤术前规划中的临床应用[J].中国普通外科杂志,2018,27(7):818-825.DOI:10.3978/j.issn.1005-6947.2018.07.004. Yuan RF,Min JQ,Wu LQ,et al.Clinical application of 3D technology in preoperative surgical planning for central liver tumor[J].Chinese Journal of General Surgery,2018,27(7):818-825.DOI:10.3978/j.issn.1005-6947.2018.07.004.
13 Huanwei C,Feiwen D.Purelaparoscopic right hemihepatectomy via anterior approach[J].Surg Endosc,2016,30(12):5621.DOI:10.1007/s00464-016-4903-0.
14 Chen HW,Deng FW,Hu JY,et al.Extra-glissonian approach for totaI laparoscopic left hepatectomy:a prosective cohort study[J].Surg Laparosc Endosc Percutan Tech,2017,27(6):145-148.DOI:10.1097/SLE.0000000000000483.
15 Chen YJ,Zhen ZJ,Chen HW,et al.Laroscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach[J].Hepatobiliary Pancreat Dis Int,2014,13(5):508-512.
16 Zhang Y,Yang H,Deng X,et al.Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extraglissionian approach in laparoscopic liver resection[J].Surg Endosc,2016,30(3):961-970. DOI:10.1007/s00464-015-4276-9.
17 Herman P,Krnger J,Lupinacci R,et al,Laparoscopic bisegmentectomy 6 and 7 using a glissonian approach and a halfpringle[J].Surg Endosc,2013,27(5):1840-1841.DOI:10.1007/s00464-012-2681-x.
18 Wang HQ,Yang JY,Yan LN.Hemihepatic versus total hepatic inflow occlusion during hepatectomy:a systematic review and metaanalysis[J] World J Gastroenterol,2011,17(26):3158-3164.DOI:10.3748/wjg.v17.i26.3158.
19 Kirchner VA,Kim KH,Kim SH,et al.Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure[J].Surg Endosc,2017,31(8):3349-3350.DOI:10.1007/s00464-016-5349-0.
20 Lee SY.Central hepatectomy for centrally located malignant liver tumors:a systematic review[J].World J Heapatol,2014,6(5):347-357.DOI:10.4254/wjh.v6.i5.347.
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备注/Memo
收稿日期:2019-03-19。
基金项目:湖南省卫生健康委员会技术创新项目（编号：湘卫医政医管处便函[2018]187号）
通讯作者:尹强,Email:qiangyin@hotmall.com