Wang Xin-Xin, Dong Bao-Long, Wu Biao, Chen Shi-Yong, He Yu, Yang Xiao-Jun
Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China.
World J Clin Cases. 2021 Jul 26;9(21):5980-5987. doi: 10.12998/wjcc.v9.i21.5980.
Caudate lobe hemangioma of the liver is relatively rare. Due to the unique anatomical location of the caudate lobe, the caudate lobectomy accounts for only 0.5% to 4% of hepatic resection, which is difficult to operate and takes a long time, and even has many postoperative complications.
A 34-year-old female presented with a 1 year history of intermittent pain in the right side of the waist without obvious inducement. All laboratory blood tests were within normal limits. Indocyanine green 15 min retention was rated 2.9%, and Child-Pugh was rated A. Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe with hemangioma of left lobe of liver. After discussion, surgical treatment was performed, which lasted 410 min, with intraoperative bleeding of about 600 mL and postoperative pathological findings of cavernous hemangioma. There were no obvious postoperative complications, and the patient was discharged 10 d after surgery.
Caudate lobectomy is difficult due to its special anatomical location. Under the condition of fully exposing the anatomy of the first porta hepatis, the second porta hepatis, the third porta hepatis, the fourth porta hepatis and middle hepatic vein and combining with the Pringle maneuver, caudate lobectomy can be performed in a precise and safe process.
肝尾状叶血管瘤相对少见。由于尾状叶独特的解剖位置，尾状叶切除术仅占肝切除术的0.5%至4%，手术难度大、耗时久，甚至术后并发症较多。
一名34岁女性，右侧腰部间歇性疼痛1年，无明显诱因。所有实验室血液检查结果均在正常范围内。吲哚菁绿15分钟潴留率为2.9%，Child-Pugh分级为A级。计算机断层扫描和磁共振成像诊断为尾状叶巨大血管瘤并合并肝左叶血管瘤。经讨论后行手术治疗，手术历时410分钟，术中出血约600毫升，术后病理结果为海绵状血管瘤。术后无明显并发症，患者术后10天出院。
由于尾状叶特殊的解剖位置，尾状叶切除术难度较大。在充分暴露第一肝门、第二肝门、第三肝门、第四肝门及肝中静脉解剖结构的情况下，结合Pringle手法，可精确、安全地实施尾状叶切除术。
