Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.
Anticancer Res. 2022 Jul;42(7):3621-3625. doi: 10.21873/anticanres.15850.
BACKGROUND/AIM: Although laparoscopic hepatectomy has been widely used in the management of liver tumors for its reduced invasiveness and magnified view, in the caudate lobe it remains challenging especially for patients with cirrhosis. Thus, this study aimed to evaluate patients undergoing laparoscopic hepatectomy for hepatic tumors in the caudate lobe and establish strategies for performing such procedure.
Laparoscopic hepatectomy in the caudate lobe was performed in nine patients. We performed inflow control to reduce bleeding during hepatic transection and retraction of the left lateral section to the cranial side to obtain a sufficient surgical field using a Nathanson liver retractor. We approached tumors in the Spiegel lobe (SP) from caudal side for segment 1 (S1) partial hepatectomy and from caudal and left side for Spiegel lobectomy, the lower paracaval portion (PC) from caudal side for S1 partial hepatectomy, and the upper PC from caudal and bilateral side for total caudate lobectomy.
In 6 cases the tumors were in the SP and in 3 cases in the PC. The types of laparoscopic hepatectomy performed were total caudate lobectomy (n=1), Spiegel lobectomy (n=2), and partial hepatectomy of segment 1 (n=6). All the tumors were curatively resected, and no patient had complications. Operative time for tumors located in the PC was significantly longer than that for tumors located in the SP. Laparoscopic hepatectomy in the caudate lobe was safely performed for five patients with liver cirrhosis.
Laparoscopic hepatectomy in the caudate lobe may become the standard surgical technique with hepatic inflow control, sufficient surgical field exposure, and appropriate approach.
背景/目的：尽管腹腔镜肝切除术因其微创性和放大的视野而广泛应用于肝脏肿瘤的治疗，但在尾状叶仍具有挑战性，尤其是对于肝硬化患者。因此，本研究旨在评估接受腹腔镜肝切除术治疗尾状叶肝脏肿瘤的患者，并制定实施该手术的策略。
对 9 例尾状叶肝脏肿瘤患者进行腹腔镜肝切除术。我们进行入肝血流控制以减少肝切除时的出血，并使用 Nathanson 肝拉钩将左外侧叶向头侧牵拉以获得足够的手术视野。我们从尾侧向 Spiegel 叶（SP）的 S1 部分肝切除术和从尾侧向左侧的 Spiegel 叶切除术接近肿瘤，从尾侧向 SP 的 S1 部分肝切除术接近 Spiegel 叶下段旁区（PC），从尾侧向双侧接近 Spiegel 叶上段旁区（PC）行全尾状叶切除术。
6 例肿瘤位于 SP，3 例位于 PC。所行的腹腔镜肝切除术类型为全尾状叶切除术（n=1）、 Spiegel 叶切除术（n=2）和 S1 部分肝切除术（n=6）。所有肿瘤均达到根治性切除，无患者发生并发症。PC 部位肿瘤的手术时间明显长于 SP 部位肿瘤。5 例肝硬化患者安全地进行了腹腔镜尾状叶切除术。
对于肝硬化患者，通过肝血流控制、充分的手术视野暴露和适当的入路，腹腔镜肝切除术可能成为标准的手术技术。
