中文摘要：

目的 探讨肝中叶切除术治疗中央型巨大原发性肝癌的适应证、方法和疗效.方法 回顾性分析2009年至2013年西安交通大学第一附属医院收治的22例中央型巨大原发性肝癌行肝中叶切除术的病例资料及随访情况.结果 肿瘤中位直径12.5 cm（10.5-22 cm）,18例为单发病灶,4例多发,合并癌栓6例.术前肝功能Child-PughA级16例,B级6例.术前中位吲哚菁绿15 min滞留率为5.2％（0.4％-9.1％）.2例术前于外院行TACE治疗,9例患者接受了术后辅助性治疗.中位手术时间265 min（180 -490 min）,术中出血量850 ml（200 -2 200 ml）,术中输血650 ml（0-2400 nml）.肝脏流入道阻断时间26 min（8-51 min）,下腔静脉阻断时间7 min（0- 14 min）.12例患者出现术后并发症,1例在术后第4天死于肝功能衰竭.术后住院时间为12 d（8-50 d）.随访1年、2年、3年总体生存率和无瘤生存率分别为81.1％、70.9％、53.2％和80.2％、31.2％、31.2％.结论 掌握手术适应证、手术技巧并作好围手术期处理,肝中叶切除术是治疗中央型巨大原发性肝癌的有效方法.

英文摘要：

Objective To evaluate the indication,techniques and efficacy of mesohepatectomy for the treatment of central huge primary hepatic carcinoma.Methods From 2009 to 2013,22 cases of centrally located huge hepatic carcinoma in First Affiliated Hospital of Xi＆#225;n Jiaotong University were retrospectively analyzed by clinical data and follow-up statistics.Results Median diameter of tumors was 12.5 cm （range 10.5 -22 cm）.18 cases were single lesion and 4 cases were multiple lesion.Tumor combined with tumor thrombus in 6 patients.The preoperative liver function was graded as A in 16 patients and B in 6 ones.The median ICG-R15 value of patients was 5.2% （range 0.4 -9.1%）.2 cases underwent TACE preoperatively in other hospitals and 9 cases of patients underwent postoperative adjuvant therapy.The median operation time was 265 min （range 180 - 490 min）,and median blood loss was 850 ml （range 200 -2 200 ml）.Intraoperative blood transfusion was 650 ml（0 - 2 400 ml）.The occlusion time of inflow tract ranged from 8 to 51 minutes,26 minutes in median.Of inferior vena cava,the value was 7 min （0 -14 min）.Postoperative complications were found in 12 patients,1 case died of hepatic failure 4 days after operation.Postoperative hospital stay was 12 days （range 8 - 50 days）.Overall survival and disease-free survival rates of 1 -,2 -,3 - years were 81.1%,70.9%,53.2% and 80.2%,31.2%,31.2% respectively.Conclusion With accurate indication,operative skill and proper perioperative treatment,mesohepatectomy is an effective method for central huge hepatic carcinnoma.