Surgery for Hepatocellular Carcinoma Located in the Caudate Lobe
Surgery for Hepatocellular Carcinoma Located in the Caudate Lobe
复制标题
DOI：
10.1007/s00268-009-0110-7
复制
发表时间：
2009-09-01
影响因子：
2.6
通讯作者：
Natsugoe, Shoji
中科院分区：
文献类型：
--
作者：
Sakoda, Masahiko;Ueno, Shinichi;Natsugoe, Shoji
肝细胞癌（HCC）起源于尾状叶的手术仍然很困难。我们的目的是评估尾状叶切除术联合其他类型肝切除术的安全性和相关问题。分析了临床和手术特点以及生存率。肿瘤位于Spiegel叶3例，尾状突6例，腔静脉旁3例。手术进行最孤立的部分尾状叶切除术（6例）。3例患者行尾状叶部分切除联合其他肝切除术，其余患者行尾状叶全切除联合其他肝切除术。行联合全尾状叶切除术的患者肿瘤主要位于腔静脉旁。接受联合切除术的6名患者的中位手术时间为400分钟，术中失血量中位数为1，683 ml。除1例尾状叶全切除联合中央双节段切除外，其余行尾状叶全切除的患者术后无并发症。在该病例中，肝脏摘除后剩余的右后部分扭曲，导致右肝静脉流出道堵塞。对于位于尾状叶的HCC，尤其是腔静脉旁部分的HCC，如果对肝储备功能和手术相关并发症有充分了解，部分或全部尾状叶切除联合其他类型的肝切除术有助于安全、治愈性手术。
Surgery remains difficult for hepatocellular carcinoma (HCC) originating in the caudate lobe. Our objective was to evaluate the safety and problems associated with caudate lobectomy combined with other types of hepatectomy.We performed caudate resection for HCC in 12 patients. Clinical and operative characteristics and survival were analyzed.Tumors were located in the Spiegel lobe in three patients, the caudate process in six, and the paracaval portion in three. The procedure performed most was isolated partial caudate lobe resection (six patients). Three patients underwent partial caudate lobe resection combined with other hepatectomy, and the remainder underwent total caudate lobe resection combined with other hepatectomy. Tumors of the patients who underwent combined total caudate lobe resection were mainly in the paracaval portion. The median operating time for the six patients who underwent combined resection was 400 min, and their median intraoperative blood loss was 1,683 ml. There were no postoperative complications in patients who underwent combined total caudate lobe resection, except one case of total resection combined with central bisegmentectomy. In that case, the remaining right posterior sector was twisted after liver extraction, causing blockage of the outflow of the right hepatic vein. The overall and recurrence-free survival rates did not differ between the isolated and combined resection groups.For removal of HCC located in the caudate lobe, especially the paracaval portion, partial or total caudate lobe resection with other types of hepatectomy contributes to safe, curative surgery if the liver functional reserve and complications associated with surgery are well understood.