Takayama T, Makuuchi M
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Hepatogastroenterology. 1998 Jan-Feb;45(19):20-3.
BACKGROUND/AIMS: Resection of the caudate lobe of the liver is difficult to perform because of a deep location and an adjacency to the major vessels.
A total of 30 patients with hepatocellular carcinoma (HCC) originating in the caudate lobe underwent hepatic resection. The lobe was classified to Spiegel's portion, the process portion, and the caval portion. The operative procedure undertaken was chosen on the basis of tumor location as well as hepatic function of each patient.
In 14 patients who had an HCC located at Spiegel's portion or the process portion, the tumor was removed by local resection of the caudate lobe (n = 10), or by resection combined with lobectomy (n = 2) or subsegmentectomy (n = 2). In 16 patients with an HCC at the caval portion, caudate lobe resections with preparatory lobectomy (n = 6), segmentectomy (n = 1), or subsegmentectomy (n = 4) were performed. In the other 5, isolated total or partial resection of the caudate lobe was carried out because of the presence of severe cirrhosis. All operations were defined as curative, but produced two operative deaths due to liver failure. The cumulative rate of overall survival was 41% at 5 years after surgery.
Caudate lobe resection for HCC can be performed even in cirrhotic patients with a favorable surgical outcome.
背景/目的：由于肝尾状叶位置深且毗邻主要血管，其切除手术难度较大。
共有30例起源于肝尾状叶的肝细胞癌（HCC）患者接受了肝切除手术。尾状叶被分为斯皮格尔部、突部和腔静脉部。手术方式根据肿瘤位置以及每位患者的肝功能来选择。
1名HCC位于斯皮格尔部或突部的患者中，通过局部切除尾状叶（n = 10）、联合肝叶切除（n = 2）或亚肝段切除（n = 2）切除了肿瘤。16名腔静脉部HCC患者接受了先行肝叶切除（n = 6）、肝段切除（n = 1）或亚肝段切除（n = 4）的尾状叶切除术。另外5名患者因存在严重肝硬化而进行了孤立的尾状叶全切除或部分切除。所有手术均定义为根治性手术，但因肝衰竭导致2例手术死亡。术后5年总生存率的累积率为41%。
即使是肝硬化患者，肝尾状叶切除治疗HCC也可取得良好的手术效果。
