孤立性尾状叶肝肿瘤切除术：手术入路和围手术期结果。

Isolated caudate lobe resection for hepatic tumor: surgical approaches and perioperative outcomes.

机构信息

Eastern Hepatobiliary Surgery Hospital, Shanghai, People's Republic of China.

出版信息

Am J Surg. 2010 Sep;200(3):346-51. doi: 10.1016/j.amjsurg.2009.10.018. Epub 2010 Apr 20.

DOI:10.1016/j.amjsurg.2009.10.018

PMID:20409523

Abstract

BACKGROUND

Caudate lobe of the liver is relatively inaccessible because of its deep location and lying between the major vascular structures. Therefore, isolated caudate lobe resection (ICLR) is a much challengeable operation.

METHODS

Review of prospectively collected data from patients who underwent ICLR for hepatic tumor.

RESULTS

Forty-six patients (mean age 46.8 years) underwent ICLR for malignant (39 cases) and benign (7 cases) hepatic tumors. ICLRs were performed by 3 different approaches and in different ways of hepatic vascular control: without any vascular control in 7 patients, under Pringle maneuver in 26 patients, and under sequential inflow and outflow vascular occlusion in 13 patients. There were no perioperative deaths, and the postoperative complication rate was 8.7% (4/46). The mean operative time was 174.5 +/- 44.3 minutes and the mean estimated intraoperative blood loss was 504.4 +/- 356.2 mL.

CONCLUSIONS

ICLR is a technically demanding but safe procedure. Choice of surgical approaches and ways of hepatic vascular control should be based on tumor location and surgeons'experience.

摘要

背景

由于肝尾叶位置深，位于大血管结构之间，因此相对难以触及。因此，孤立性肝尾叶切除术（ICLR）是一项极具挑战性的手术。

方法

回顾性分析了 46 例因肝肿瘤行 ICLR 的患者的前瞻性资料。

结果

46 例患者（平均年龄 46.8 岁）因肝恶性肿瘤（39 例）和良性肿瘤（7 例）行 ICLR。采用 3 种不同的入路和不同的肝血管控制方法进行 ICLR：7 例无血管控制，26 例采用 Pringle 手法，13 例采用顺行和逆行血流阻断法。无围手术期死亡，术后并发症发生率为 8.7%（4/46）。平均手术时间为 174.5±44.3 分钟，术中估计出血量为 504.4±356.2ml。