Shimada Kazuaki, Sano Tsuyoshi, Sakamoto Yoshihiro, Kosuge Tomoo
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, 104-0045, Chuo-ku, Tokyo, Japan.
World J Surg. 2005 Jun;29(6):723-7. doi: 10.1007/s00268-005-7704-5.
Left hepatic trisegmentectomy has been performed for huge malignant tumors, but it is rarely applied in patients with hilar cholangiocarcinoma. Twelve consecutive patients (7 men and 5 women; mean age, 64 years) underwent left hepatic trisegmentectomy in our institution between January 2000 and December 2003. The preoperative management and postoperative outcomes of this surgical procedure were presented and retrospectively analyzed. Preoperative biliary drainage and portal vein embolization were performed in 6 patients (50%) and 9 patients (75%), respectively. The preoperative estimated volume ratio of the posterior segment /the whole liver was 44.8 +/- 7.0% (34.3-54.3), the plasma retention rate of indocyanine green at 15 minutes was 8.6 +/- 2.2% (4.7-13.7), and the serum total bilirubin level before surgery was 1.0 +/- 0.4 mg/dl (0.4-1.7). The serum total bilirubin level on the first postoperative day was 3.3 +/- 0.4 mg/dl (1.4-6.2). There was no hospital death or postoperative hepatic failure. The incidence of positive resectional margin was 25%. With biliary decompression and preoperative portal embolization techniques, left hepatic trisegmentectomy was a safe and curative resectional option for hilar cholangiocarcinoma.
左半肝三叶切除术已用于治疗巨大恶性肿瘤，但很少应用于肝门部胆管癌患者。2000年1月至2003年12月期间，我院连续12例患者（7例男性，5例女性；平均年龄64岁）接受了左半肝三叶切除术。本文介绍并回顾性分析了该手术的术前管理和术后结果。分别有6例患者（50%）和9例患者（75%）进行了术前胆道引流和门静脉栓塞。术前估计后段/全肝的体积比为44.8±7.0%（34.3 - 54.3），吲哚菁绿15分钟血浆潴留率为8.6±2.2%（4.7 - 13.7），术前血清总胆红素水平为1.0±0.4mg/dl（0.4 - 1.7）。术后第1天血清总胆红素水平为3.3±0.4mg/dl（1.4 - 6.2）。无医院死亡或术后肝衰竭发生。切缘阳性率为25%。采用胆道减压和术前门静脉栓塞技术，左半肝三叶切除术是肝门部胆管癌一种安全有效的切除选择。
