Takayama T, Makuuchi M, Kosuge T, Yamazaki S, Hasegawa H, Takayama J, Takayasu K, Moriyama N
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Surgery. 1991 Feb;109(2):208-13.
Complete resection of a rare hepatoblastoma in the caudate lobe, involving the inferior vena cava (IVC), is reported. After systemic chemotherapy, a 5-year-old child underwent exploratory laparotomy at another hospital, but resection was not attempted because the tumor in the caudate lobe had extensively invaded the retrohepatic IVC. However, because not only the lack of distant metastases but also the establishment of extrahepatic collaterals were confirmed by imaging, we thought it was possible to radically resect the tumor. We successfully performed an extended left hepatic lobectomy including total excision of the caudate lobe and the involved portion of the IVC. Although we did not reconstruct the IVC, no clinical manifestations arising from caval congestion were seen. The serum alpha-fetoprotein value declined below the normal limit. Our experience with this case has introduced a radical resectability for hepatic malignancy in the caudate lobe, even if it has extended into the IVC.
本文报道了一例罕见的尾状叶肝母细胞瘤的完整切除病例，该肿瘤侵犯了下腔静脉（IVC）。经过全身化疗后，一名5岁儿童在另一家医院接受了剖腹探查术，但由于尾状叶肿瘤广泛侵犯肝后下腔静脉，未尝试进行切除。然而，由于影像学检查不仅证实没有远处转移，而且还建立了肝外 collateral，我们认为有可能根治性切除肿瘤。我们成功地进行了扩大左肝叶切除术，包括尾状叶和受累下腔静脉部分的完全切除。虽然我们没有重建下腔静脉，但未出现因腔静脉充血引起的临床表现。血清甲胎蛋白值降至正常范围以下。我们对该病例的经验表明，即使尾状叶肝恶性肿瘤已侵犯下腔静脉，也可实现根治性切除。
