Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Surg Today. 2012 Jan;42(1):46-51. doi: 10.1007/s00595-011-0021-8. Epub 2011 Nov 11.
We analyzed the feasibility and safety of our preliminary surgical approach for total hepatic resection of the right hepatic vein drainage area (THR-RHV) with the aid of three-dimensional computed tomography (3D-CT) guidance.
Clinical findings and 3D-CT volumetry results were investigated in five patients who underwent THR-RHV for a hepatic malignant tumor close to the right hepatic vein (RHV).
The mean estimated remnant liver volume after a conventional right lobectomy was 474 ml, whereas that after THR-RHV was 614 ml, indicating that 140 ml (13.8%) of additional liver volume had been preserved by performing THR-RHV. The median operative time, mean ischemic time, and mean blood loss during surgery were 406 min, 51 min, and 587 ml, respectively. Histological examinations confirmed a negative surgical margin in all five patients. The mean liver volume estimated by 3D-CT was 458 ml, whereas the mean actual resected liver volume was 468 g, resulting in a mean error ratio of 3.1%.
THR-RHV allowed for a higher remnant liver volume than that after conventional right lobectomy of the liver, and proved feasible with acceptable perioperative results. This technique thus promotes both safety and curability for patients with a tumor close to the RHV.
我们分析了在三维计算机断层扫描（3D-CT）引导下，采用初步的肝右静脉引流区全肝切除术（THR-RHV）的可行性和安全性。
对 5 例肝恶性肿瘤靠近肝右静脉（RHV）行 THR-RHV 的患者的临床资料和 3D-CT 体积测量结果进行了研究。
常规右半肝切除后估计剩余肝体积的平均值为 474ml，而 THR-RHV 后为 614ml，表明通过 THR-RHV 可保留 140ml（13.8%）的额外肝体积。手术的中位时间、平均缺血时间和平均术中出血量分别为 406 分钟、51 分钟和 587ml。组织学检查证实所有 5 例患者均有阴性手术切缘。3D-CT 估计的平均肝体积为 458ml，而实际切除的肝体积平均为 468g，平均误差比为 3.1%。
THR-RHV 可获得比常规右半肝切除更高的剩余肝体积，且具有可接受的围手术期结果，是可行的。该技术可提高靠近 RHV 的肿瘤患者的安全性和可治愈性。
