Miyake Hidenori, Tashiro Seiki, Fujii Masahioko, Sasaki Katsuya, Takagi Toshihide
Department of Digestive Surgery, University of Tokushima School of Medicine, Tokushima, Japan.
Hepatogastroenterology. 2004 Mar-Apr;51(56):372-4.
We report two cases that underwent extended left hepatic lobectomy combined with resection of the caudate lobe and extrahepatic bile duct only from the left side approach for hilar cholangiocarcinoma. The first case was a 54-year-old man and the second one was a 63-year-old man. Both patients had hilar cholangiocarcinoma with predominant left hepatic duct involvement and required resection and reconstruction of the right hepatic artery as well as left hepatic lobectomy. In both cases, the right hepatic lobe was never mobilized to protect the mechanical damage in the remnant liver and keep co-lateral blood supply route to the remnant liver from the diaphragm or retroperitoneum. Although arterial blood flow to the remnant right hepatic lobe was unfortunately insufficient after reconstruction of the right hepatic artery, the postoperative course was uneventful. The postoperative angiography showed co-lateral arterial blood supply to the right lobe via the subdiaphragmatic artery. In case of extended left hepatic lobectomy combined with resection of the caudate lobe and right hepatic artery, ipsilateral approach (approach only from the left side) is recommended.
我们报告了两例因肝门部胆管癌接受扩大左肝叶切除术联合尾状叶及肝外胆管切除的病例，手术仅采用左侧入路。第一例为一名54岁男性，第二例为一名63岁男性。两名患者均为肝门部胆管癌，主要累及左肝管，需要切除并重建右肝动脉以及进行左肝叶切除术。在这两例手术中，均未游离右肝叶，以保护残余肝脏的机械性损伤，并保持来自膈肌或腹膜后的侧支血供途径至残余肝脏。尽管右肝动脉重建后，残余右肝叶的动脉血流不幸不足，但术后过程顺利。术后血管造影显示通过膈下动脉向右侧叶提供侧支动脉血供。对于扩大左肝叶切除术联合尾状叶及右肝动脉切除的情况，建议采用同侧入路（仅从左侧入路）。
