Bartlett D, Fong Y, Blumgart L H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Br J Surg. 1996 Aug;83(8):1076-81. doi: 10.1002/bjs.1800830812.
The caudate lobe of the liver is a frequent site of involvement by metastatic or primary liver tumours. This study describes the surgical anatomy and analyses the operative technique, results and postoperative morbidity of complete caudate lobectomy. The data represent a retrospective review of 21 consecutive complete caudate lobe resections performed over a 30-month period. The most common diagnosis was metastatic colorectal cancer (nine patients) and the most common procedure was extended left hepatic lobectomy with en bloc caudate lobectomy. Four patients underwent isolated complete caudate lobe resection. The median operating time was 5 h and the median blood loss was 1160 ml. The major complication rate was 38 per cent (nine major complications in eight patients) with 10 per cent mortality rate (two deaths). The median hospital stay was 11 days. This series demonstrates the feasibility of routine complete caudate lobe resection for tumours with general principles of liver resection. Isolated caudate lobectomy can be performed safely and the addition of caudate lobectomy to major liver resection does not add significantly to the morbidity or mortality of the procedure.
肝尾状叶是转移性或原发性肝肿瘤常见的累及部位。本研究描述了肝尾状叶的手术解剖结构，并分析了完整肝尾状叶切除术的手术技术、结果及术后发病率。这些数据是对30个月内连续进行的21例完整肝尾状叶切除术的回顾性研究。最常见的诊断是转移性结直肠癌（9例患者），最常见的手术方式是扩大左肝叶切除术联合整块肝尾状叶切除术。4例患者接受了单纯完整肝尾状叶切除术。中位手术时间为5小时，中位失血量为1160毫升。主要并发症发生率为38%（8例患者出现9例主要并发症），死亡率为10%（2例死亡）。中位住院时间为11天。本系列研究表明，按照肝切除的一般原则，对肿瘤进行常规完整肝尾状叶切除术是可行的。单纯肝尾状叶切除术可安全实施，在主要肝切除术中加做肝尾状叶切除术并不会显著增加手术的发病率或死亡率。
