Systematic extended right posterior sectionectomy - A safe and effective alternative to right hepatectomy
Systematic extended right posterior sectionectomy - A safe and effective alternative to right hepatectomy
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DOI：
10.1097/sla.0b013e31816387d7
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发表时间：
2008-04-01
影响因子：
9
通讯作者：
Montorsi, Marco
中科院分区：
文献类型：
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作者：
Torzilli, Guido;Donadon, Matteo;Montorsi, Marco
背景：基于超声引导的肝切除术的手术方法可以最大限度地减少大切除的需要，其发病率和死亡率是不可忽视的。右肝切除(RH)的传统手术方式为右肝静脉血管侵犯、右后段多发肿瘤和/或门静脉右后支(P6-7)肿瘤与门静脉右前支(P5-8)相接触。我们在此描述了一种治疗RH的替代方法，包括超声引导下系统性扩大右后叶切除术(SERPS)。方法：在207例连续接受肝切除术的患者中，21例(10%)接受了SERPS。中位年龄67岁(范围48-79岁)。男13例，女8例。肝细胞癌10例(48%)，结直肠癌肝转移11例(52%)，肿瘤个数中位数2个(1~15个)，肿瘤大小中位数4.5 cm(2.5~20个)。10例(48%)患者有肝硬变，8例(38%)患者有脂肪变性，3例(16%)患者肝脏正常。手术策略基于术中超声(IOUS)中肿瘤与血管的关系和彩色多普勒超声所见。结果：住院和90天的死亡率为零。严重并发症3例(14%)，轻微并发症2例(9.5%)。无一例因并发症再次手术。输血2例(9.5%)。中位随访21个月，未见局部复发。结论：IOUS引导下SERPS是可行的、安全的、有效的。应尽可能将其作为RH的替代切除，以最大限度地保留肝实质。
Background: A surgical approach based on ultrasound-guided hepatectomy might minimize the need for major resection, whose rates of morbidity and mortality are not negligible. Right hepatectomy (RH) is traditionally performed in cases of vascular invasion of the right hepatic vein with multiple tumors in the right posterior section, and/or of the right posterior portal branch (P6-7) with tumor in contact with right anterior portal branch (P5-8). We herein describe an alternative approach to RH consisting in ultrasound-guided systematic extended right posterior hepatic sectionectomy (SERPS).Methods: Among 207 consecutive patients who underwent hepatectomies, 21 (10%) underwent SERPS. Median age was 67 years (range, 48-79). There were 13 men and 8 women. Ten (48%) patients had hepatocellular carcinoma; 11 (52%) had colorectal liver metastases, Median tumor number was 2 (range, 1- 15); median tumor size was 4.5 cm (range, 2.5-20). Ten (48%) patients had cirrhosis, 8 (38%) had steatosis, and 3 (16%) had normal liver. Surgical strategy was based on tumor-vessels relationship at intraoperative ultrasonography (IOUS) and on findings at color-Doppler IOUS.Results: In-hospital and 90-days mortality were nil. Major and minor morbidity occurred in 3 (14%) and 2 (9.5%) patients, respectively. No patients were reoperated because of complications. Blood transfusions were given to 2 (9.5%) patients. After a median follow-up of 21 months, no local recurrence was observed.Conclusions: IOUS-guided SERPS is feasible, safe, and effective. It should be applied whenever possible as alternative resection to RH to maximize liver parenchymal sparing.