First Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Hepatobiliary Pancreat Dis Int. 2012 Aug 15;11(4):377-82. doi: 10.1016/s1499-3872(12)60195-7.
Caudate lobectomy has long been considered technically difficult. This study aimed to elaborate the significance of early control of short hepatic portal veins (SHPVs) in isolated hepatic caudate lobectomy or in hepatic caudate lobectomy combined with major partial hepatectomy, and to describe the anatomical characteristics of SHPVs.
The data of 117 patients who underwent either isolated or combined caudate lobectomy by the same team of surgeons from 2005 to 2009 were retrospectively analyzed. From 2005 to 2007 (group A, n=55), we carried out early control of short hepatic veins (SHVs) only; from 2008 to 2009 (group B, n=62), we carried out early control of both SHVs and SHPVs. The two groups were compared to evaluate which surgical procedure was better. A detailed anatomical study was then carried out on the last 25 consecutive patients in group B to study the number and distribution of SHPVs during surgery.
Patients in group B had less intra-operative blood loss, less impairment of liver function, shorter postoperative hospital stay, fewer postoperative complications and required less blood transfusion (P<0.05). The number of SHPVs in the 25 patients was 183, with 7.3+/-2.7 per patient. The diameters of SHPVs were 1 to 4 mm. On average, 3.4 SHPVs/patient came from the left portal vein, 2.2 from the bifurcation, 1.4 from the right portal vein, and 0.3 from the main portal vein. On average, 3.3 SHPVs/patient supplied segment I of the liver, 0.4 for segment II, 2.1 for segment IV, 1.4 for segment V and 0.1 for segment VI.
Early control of SHPVs in isolated or combined hepatic caudate lobectomy may be a useful method to decrease surgical risk and improve postoperative recovery.
尾状叶切除术一直被认为具有技术难度。本研究旨在阐述在孤立性肝尾状叶切除术或肝尾状叶切除术联合肝大部切除术时早期控制短肝门静脉（SHPVs）的意义，并描述 SHPVs 的解剖学特征。
回顾性分析 2005 年至 2009 年间同一手术团队对 117 例患者进行的孤立性或联合肝尾状叶切除术的数据。2005 年至 2007 年（A 组，n=55），仅行短肝静脉（SHV）早期控制；2008 年至 2009 年（B 组，n=62），行 SHV 和 SHPV 早期控制。比较两组以评估哪种手术方法更好。然后对 B 组的最后 25 例连续患者进行详细的解剖学研究，以研究术中 SHPV 的数量和分布。
B 组患者术中出血量减少，肝功能损害减轻，术后住院时间缩短，术后并发症减少，输血需求减少（P<0.05）。25 例患者的 SHPV 数量为 183 个，平均每个患者 7.3+/-2.7 个。SHPV 直径为 1 至 4 毫米。平均而言，每个患者有 3.4 个 SHPV 来自左门静脉，2.2 个来自分叉处，1.4 个来自右门静脉，0.3 个来自主门静脉。平均而言，每个患者有 3.3 个 SHPV 供应肝脏 I 段，0.4 供应 II 段，2.1 供应 IV 段，1.4 供应 V 段，0.1 供应 VI 段。
在孤立性或联合肝尾状叶切除术时早期控制 SHPVs 可能是降低手术风险和改善术后恢复的有用方法。
