Wang Zhen-Guang, Lau WanYee, Fu Si-Yuan, Liu Hui, Pan Ze-Ya, Yang Yuan, Zhang Jin, Wu Meng-Chao, Zhou Wei-Ping
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China.
J Gastrointest Surg. 2015 May;19(5):880-6. doi: 10.1007/s11605-015-2793-4. Epub 2015 Mar 11.
Complete caudate lobectomy using the anterior hepatic parenchymal transection approach is a proper but technically demanding operation for tumors situated in or involving the paracaval portion of the caudate lobe. This study was intended to share our experience on this operation.
Forty-nine consecutive patients who received complete caudate lobectomy using the anterior hepatic parenchymal transection approach were studied. The clinicopathologic and perioperative data, complications, and survival were analyzed.
Of the 49 patients, 15 (30.6 %) received isolated complete caudate lobectomy and 34 (69.4 %) received complete caudate lobectomy associated with segmentectomy IV. The median tumor size was 7.3 cm (2.4-18.0 cm), the operating time was 200 min (120-370 min), and the operative blood loss was 700 ml (200-3000 ml). The postoperative complication rate was 36.7 %. There was no perioperative death. Patients in the associated complete caudate lobectomy group had larger tumors (P<0.001), higher platelet counts (P=0.033), shorter operation time (P=0.004), and less patients with residual tumor (P=0.03) than those in the isolated complete caudate lobectomy group. There were no significant differences in cirrhosis, surgical resection margin, blood loss, postoperative complications, and prognosis between the two groups.
Complete caudate lobectomy using the anterior hepatic parenchymal transection approach was technically feasible and safe for patients with tumors situated in or involving the paracaval portion of the caudate lobe. Associated resection of segment IV can be used to facilitate the surgery and decrease the chance of local residual tumor.
采用肝实质前入路行完整尾状叶切除术，对于位于或累及尾状叶腔静脉旁部分的肿瘤而言，是一种合适但技术要求较高的手术。本研究旨在分享我们在该手术方面的经验。
对49例采用肝实质前入路行完整尾状叶切除术的连续患者进行研究。分析其临床病理、围手术期数据、并发症及生存情况。
49例患者中，15例（30.6%）接受单纯完整尾状叶切除术，34例（69.4%）接受完整尾状叶切除术联合IV段切除术。肿瘤中位大小为7.3 cm（2.4 - 18.0 cm），手术时间为200分钟（120 - 370分钟），术中失血700毫升（200 - 3000毫升）。术后并发症发生率为36.7%。无围手术期死亡。与单纯完整尾状叶切除术组相比，完整尾状叶切除术联合IV段切除术组患者肿瘤更大（P<0.001）、血小板计数更高（P = 0.033）、手术时间更短（P = 0.004）、肿瘤残留患者更少（P = 0.03）。两组在肝硬化、手术切缘、失血、术后并发症及预后方面无显著差异。
对于位于或累及尾状叶腔静脉旁部分肿瘤的患者，采用肝实质前入路行完整尾状叶切除术在技术上是可行且安全的。联合IV段切除术可用于促进手术并降低局部肿瘤残留的几率。
