肝尾状叶肿瘤切除的技术难点与对策

Technical difficulties and countermeasures of caudate lobectomy

由于肝尾状叶独特的形态和解剖学结构特点，肝尾状叶肿瘤切除术仍是肝脏外科的难点。安徽医科大学第一附属医院于2011年5月对1例38岁男性肝尾状叶巨大复发性肝癌患者，在阻断第一肝门和肝下下腔静脉情况下施行肝尾状叶肿瘤切除术，但由于术中出血量达1000 ml，被迫中断手术，采取输血、保温等治疗后，施行腔静脉钳阻断下腔静脉右侧壁，完成肝尾状叶肿瘤的完整切除。患者术后恢复良好，随访14个月肿瘤无复发。该例患者的疗效证明：术者需做好充分而准确的术前评估和判断，明确手术适应证，娴熟掌握肝脏外科各项手术技巧，才能安全实施手术。

Caudate lobectomy is still a great challenge for surgeons due to unique anatomy of caudate lobe. A 38-year-old male patient with a huge recurrent hepatic cancer （diameter=16 cm） in caudate lobe received caudate lobectomy with portal triad and inferior vena cava clamping. The operation was paused due to hemorrhage （volume of blood loss=1000 ml）. After heat preservation and blood transfusion, the caudate lobectomy was completely removed with inferior vena cava clamping. The patient gradually recovered, and no tumor recurrence was detected during the follow up （14 months）. Caudate lobectomy could be safely carried out under the condition of accurate preoperational estimation, clear indication for surgery and precise hepatectomy.