Chen Xi, Li Bo, He Wei, Wei Yong-Gang, Du Zheng-Gui, Jiang Li
Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Hepatobiliary Pancreat Dis Int. 2014 Jun;13(3):264-70. doi: 10.1016/s1499-3872(14)60253-8.
Extended hemihepatectomy is usually recommended to treat large centrally located hepatocellular carcinoma (HCC). However, the morbidity and mortality are high because of the postoperative liver failure. Mesohepatectomy is seldom used because of its technical complexity. This study aimed to evaluate the short-term and long-term curative effect of mesohepatectomy.
From January 2002 to September 2008, a total of 198 consecutive patients with centrally located HCC underwent hepatectomy in our department. According to the surgical procedures, they were divided into mesohepatectomy (group M, n=118), extended right hemihepatectomy (group RE, n=47) and extended left hemihepatectomy (group LE, n=33) groups. The surgical techniques, clinical pathological characteristics and outcomes were compared between group M, group RE and group LE.
The operative time of group M was significantly longer than that of the other two groups (P<0.05); however the total bilirubin on postoperative day 3 in group M was the lowest among the three groups (P<0.01). In group M, the number of the patients whose resection margin achieving 1 cm was significantly lower than that of the other two groups (P<0.05). The mortality rates in groups M, RE and LE were 2.5%, 8.5% and 3.0%, respectively (P>0.05). The morbidity rate in group M was significantly lower than that in group RE (37.3% vs 55.3%, P=0.034), but not in group LE (37.3% vs 24.2%, P=0.163). The biliary leakage tended to be more common in group M (10.2%, P>0.05). The incidence of postoperative liver failure in group M was significantly lower than that in group RE (1.7% vs 10.6%, P=0.032), but not in group LE (1.7% vs 6.1%, P=0.208). The 1-, 3- and 5-year tumor-free survival rates and the overall survival rates after mesohepatectomy were 53.4%, 30.5% and 16.9% and 67.8%, 45.5% and 28.9%, respectively.
Mesohepatectomy is a safe and effective technique for centrally located HCC patients. Compared with extended right hemihepatectomy, mesohepatectomy can retain residual liver volume to the maximum limit and reduce postoperative liver failure rate. But no significant advantage was found compared mesohepatectomy to extended left hemihepatectomy.
扩大半肝切除术通常被推荐用于治疗位于肝脏中央的大型肝细胞癌（HCC）。然而，由于术后肝衰竭，其发病率和死亡率较高。中肝切除术因其技术复杂性很少被使用。本研究旨在评估中肝切除术的短期和长期疗效。
2002年1月至2008年9月，共有198例连续的肝脏中央型HCC患者在我科接受肝切除术。根据手术方式，将他们分为中肝切除术组（M组，n = 118）、扩大右半肝切除术组（RE组，n = 47）和扩大左半肝切除术组（LE组，n = 33）。比较M组、RE组和LE组的手术技术、临床病理特征及预后。
M组手术时间显著长于其他两组（P < 0.05）；然而，M组术后第3天总胆红素在三组中最低（P < 0.01）。M组切缘达到1 cm的患者数量显著低于其他两组（P < 0.05）。M组、RE组和LE组的死亡率分别为2.5%、8.5%和3.0%（P > 0.05）。M组发病率显著低于RE组（37.3%对55.3%，P = 0.034），但与LE组相比无显著差异（37.3%对24.2%，P = 0.163）。M组胆漏更常见（10.2%，P > 0.05）。M组术后肝衰竭发生率显著低于RE组（1.7%对10.6%，P = 0.032），但与LE组相比无显著差异（1.7%对6.1%，P = 0.208）。中肝切除术后1年、3年和5年无瘤生存率及总生存率分别为53.4%、30.5%、16.9%和67.8%、45.5%、28.9%。
中肝切除术对于肝脏中央型HCC患者是一种安全有效的技术。与扩大右半肝切除术相比，中肝切除术能最大程度保留残余肝体积并降低术后肝衰竭发生率。但与扩大左半肝切除术相比未发现显著优势。
