肝尾状叶恶性肿瘤行手术治疗51例临床分析

Surgical Treatment of Malignant Tumors at Caudate Lobe of Liver in 51 Cases

目的 探讨肝尾状叶恶性肿瘤的手术切除方式及手术安全性,并总结手术经验。方法 回顾性分析笔者所在医院2007年5月至2013年12月期间行肝尾状叶切除术的51例肝尾状叶恶性肿瘤患者的临床病理资料,对其手术方式、手术路径、并发症发生率及生存率进行总结。结果 51例肝尾状叶恶性肿瘤患者均顺利切除癌灶,其中30例行单独尾状叶切除,21例联合其他肝叶切除;9例行逆行性肝尾状叶切除术。手术时间180.0～360.0 min,平均244.0 min;术中出血量400.0～1 000.0 m L,平均630.0 m L。全组均无手术死亡,无术后大出血发生。术后发生明显并发症17例,均经保守治疗治愈或改善。术后51例患者获访,随访时间6～60个月,中位数为38.0个月。随访期间死亡29例,复发21例,转移12例;其1、3及5年累积生存率分别为76.1%、54.7%及31.8%。结论 肝尾状叶切除术治疗尾状叶恶性肿瘤是有效和可行的。

Objective To review the clinical experience and evaluate the results in patients who underwent caudate lobectomy for malignant tumor at caudate lobe of liver. Methods Clinicopathological characteristics of 51 patients who underwent caudate lobectomy because of malignant tumors at caudate lobe of liver in our hospital from May 2007 to December 2013 were reviewed retrospectively, and operative detail, complication rate, and survival rate were described. Results The cancer were resected successfully in 51 patients with malignant tumors at caudate lobe of liver. Thirty patients were performed isolated caudate lobectomy and 21 patients performed combined lobectomy. Of the 51 patients, 9 patients were treated with retrograde caudate lobectomy. The operation time was 180.0-360.0 min, with the average value of 244.0 min. The bleeding volume was 400.0-1 000.0 m L, with the average value of 630.0 m L. In all patients, there was no perioperative death and no postoperative bleeding happened, and 17 patients who suffered from interrelated complications were cured or got better by conservative treatments. Fifty-one patients were followed up for 6-60 months, and the median survival time was 38.0 months. During the follow-up period, 29 patients dead, 21 patients suffered from recurrence, and 12 patients suffered from metastasis. The cumulative survival rates of 1-, 3-, and 5-year were 76.1%, 54.7%, and 31.8% respectively after caudate lobectomy. Conclusion The caudate lobectomy in treatment of malignant tumor at caudate lobe of liver is effective and feasible.