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关键词:
- 产前诊断 /
- 快速非整倍体检测技术 /
- 荧光质位杂交技术 /
- 荧光定童聚合酶链反应
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2012年4月，北京协和医院肝脏外科联合胸外科、麻醉科、ICU及输血科等，成功完成1例巨大肝脏血管瘤切除手术。肿瘤长径达48 cm，总重量约11. 9 kg，手术中洗出血液8400 ml。目前患者已康复出院。
这位来自安徽农村的中年女性患者，早在1990年就诊断出肝血管瘤，并在当地医院接受了胸腹部联合切口的肿瘤切除术，但手术未获成功。20余年来，瘤体不断增大，患者腹部明显膨隆，生活陷入极度痛苦中。今年3月，患者怀着最后一线希望来到北京协和医院求治。
协和肝脏外科对此病例进行了认真研究。检查显示，患者右肝巨大血管瘤占据整个腹腔、右侧胸腔和部分盆腔，左肝外侧叶和脾脏已经被推挤至盆腔，心脏被明显推向左侧。用该科独创的术前肝脏功能评估系统“钟氏系统”对患者肝功能进行评估，发现患者左肝外侧叶的功能可以基本满足术后生存，为手术治疗提供依据。
患者重度贫血(血红蛋白不足70 g/L)和严重营养不良，给手术造成更大困难。在医务处组织下，肝脏外科、胸外科、麻醉科、手术室、输血科和ICU等相关科室对该病例进行了联合讨论，决定采取胸腹部联合切口进行手术。
4月10日，肝脏外科卢欣教授和胸外科李力医师等组成的手术组克服了重重难关: 20多年前的第1次手术留下的粘连疤痕，使薄薄的血管瘤壁极易破损; 巨大的瘤体将肝脏相关血管推压变异，使分离缺乏解剖依据; 一大块瘤体位于右侧胸腔，膈肌薄如纸片，须深入胸腔分理出心耳，才能找到下腔静脉。手术小组经过11个小时的努力，最终将肿瘤成功切除。
(北京协和医院肝脏外科 徐意瑶 党委综合办 段文利)
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