经肝正中裂单独施行肝尾叶全切除治疗肝尾叶肿瘤六例报告

Isolated complete caudate lobectomy through the anterior transhepatic approach:a report of 6 cases

目的探讨经肝正中裂途径施行单独尾叶全切除治疗尾叶肿瘤可行性。方法 1994年至 2 0 0 0年 10月我院施行经肝正中裂尾叶单独全切除术 6例 ,包括 1例血管瘤 ,5例肝癌 (HCC)。进行肝门解剖时不阻断肝门部血管 ,在分离肝中裂和离断尾叶与右后叶的联系时进行入肝血流间歇阻断。结果 6例手术均顺利完成 ,手术平均费时 2 85min ,术中平均失血量 16 0 0ml。全组无术中死亡 ,1例HCC在术后 17个月因肿瘤复发死亡 ,其余 4例均仍存活 ,最长者已达 49个月。结论孤立于肝尾叶的肿瘤 ,如果瘤体较大可以采用经肝正中裂的单独尾叶全切除。

Objective To study the feasibility of isolated complete resection of caudate lobe by the anterior transhepatic approach.Method From 1994 to Oct.2000, 6 cases underwent isolated complete caudate lobetomy by the anterior transhepatic approach for hemangioma(1 case), and hepatocellular carcinoma (HCC, 5 cases).Result The surgery was successful in all the 6 cases. Operating time averaged at 285?min with average blood loss of 1?600?ml. During dissection at the hepatic hila, we did not use hepatic blood inflow exclusion. Intermittant inflow exclusion was only used when liver transection was being performed, including splitting the interlober plane. There was no operative mortality. One HCC case died of recurrence 17 months later. The other 4 HCC cases were still alive at the end of this follow-up, with the longest survival of 49 months in 1 case. Conclusion Anterior transhepatic approach for isolated resection of the caudate lobe is feasible for solitary tumor originating in the caudate lobe of the liver.