尾状叶肝癌的外科诊疗:附51例报告

Surgical treatment of hepatocellular carcinoma in the caudate lobe: a report of 51 cases

背景与目的:尾状叶因其位置深,解剖关系复杂,手术切除难度高、风险大。尾状叶肝癌切除术一直是肝脏外科手术的难点。本文旨在探讨尾状叶肝癌外科治疗的可行性与安全性。方法:回顾性分析2008—2018年中南大学湘雅医院51例尾状叶肝癌切除术患者的临床资料。结果:51例患者均顺利完成手术。手术入路包括左入路8例、右入路5例、前入路10例和左右联合入路28例。手术平均时间(198.4±101.6)min,断肝时间30(10~118)min,术中出血量700.8(240~7700)m L,术中输血量602.9(0~6500)m L。术后并发症发生率15.7%,其中胆汁漏4例,腹腔积液2例,肝功能衰竭1例,术后出血1例,经对症治疗后顺利恢复。围术期无死亡病例。51例患者术后随访2.5~68.6个月,术后总复发率为55.4%;术后1、3、5年总体生存率分别为90.5%、71.2%和52.8%。结论:在严格掌握手术适应证,熟知肝尾状叶解剖特点,选择最佳手术入路,合理采用先进的切除技术的前提下,尾状叶肝癌切除是安全可行的。

Background and Aims: Resection of the caudate lobe is difficult and risky, because of its deep location and complex anatomical structure. Surgical resection of the caudate lobe for hepatocellular carcinoma(HCC) has long been a challenging problem in liver surgery. Therefore, this study was conducted to assess the feasibility and safety of surgical treatment of HCC in the caudate lobe. Methods: The clinical data of 51 patients with HCC in the caudate lobe who underwent surgical resection from 2008 to 2018 in Xiangya Hospital of Central South University were retrospectively analyzed.Results: Operations were all uneventfully completed in the 51 patients. Surgical approaches included the left approach in 8 cases, the right approach in 5 cases, the anterior approach in 10 cases, and the left-right combined approach in 28 cases. The average operative time was(198.4±101.6) min, the time of liver parenchymal transection was 30(10–118) min, the intraoperative blood loss was 700.8(240–7 700) m L, and the amount of intraoperative blood transfusion was 602.9(0–6 500) m L. The incidence rate of postoperative complications was 15.7%, including bile leakage occurred in 4 cases, abdominal fluid collection occurred in 2 cases, hepatic failure occurred in one case, and postoperative bleeding occurred in one case, which were all recovered by symptomatic treatment. No death occurred during perioperative period. The 51 patients were followed up for 2.5 to 68.6 months, the overall recurrence rate was 55.4%, and the 1-, 3-, and 5-year overall survival rates after surgery were 90.5%, 71.2%, and 52.8%, respectively.Conclusion: By strictly following the indications for surgery, familiarizing with the anatomical characteristics of the caudate lobe, and selecting the best surgical approach, resection of the caudate lobe liver cancer is safe and feasible.