Characteristics of hepatocellular carcinoma originating in the caudate lobe
Characteristics of hepatocellular carcinoma originating in the caudate lobe
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原发于尾状叶的肝细胞癌的特点
DOI：
10.1002/hep.1840190417
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发表时间：
1994
期刊：
影响因子：
13.5
通讯作者：
K. Sugimachi
中科院分区：
文献类型：
--
作者：
M. Shimada;T. Matsumata;T. Maeda;K. Yanaga;A. Taketomi;K. Sugimachi
对9例尾状叶起源的肝细胞癌患者行肝切除术。根据Kumon的标准，将尾状叶分为3个部分，即Spiegel叶、腔静脉旁部分和尾状突部。肿瘤位于Spiegel叶4例，腔静脉旁4例，尾状突1例。手术包括右肝叶切除1例，中央二段切除1例，尾状叶切除7例。平均手术时间为379±129min，术中出血量为2994±2303ml，腔静脉旁较Spiegel叶手术风险更明显。此外，大多数患者经历了显著的术后并发症。随访6个月或以上的8名患者中有6名复发，6名患者中有2名死亡。尾状叶肝细胞癌的特点是：(A)手术风险较高，且腔静脉旁的风险更明确；(B)早期复发率较高。从尾状叶的门脉供血角度出发，左肺切除Spiegel叶，右或左三段切除腔旁部分，右叶切除尾状叶。然而，对于肝硬变患者，尾状叶切除或部分切除可能是更好的选择，因为可以预期更长的生存时间。(《肝病》1994；19：911-915。)
Nine patients with hepatocellular carcinoma originating in the caudate lobe who underwent hepatic resection were studied. The caudate lobe was divided into three parts, according to the criteria of Kumon, including the Spiegel lobe, the paracaval portion and the caudate process. The tumors were located in the Spiegel lobe in four, the paracaval portion in four and the caudate process in one. Surgical procedures consisted of right hepatic lobectomy in one, central bisegmentectomy in one and caudate lobectomy in seven. The mean surgical time was 379 ± 129 min; the mean estimated blood loss was 2,994 ± 2,303 ml. The abovementioned surgical risks were more clearly recognized in the paracaval portion than in the Spiegel lobe. In addition, most patients experienced significant postoperative complications. Six of eight patients with 6 mo or longer follow‐up had recurrences, and two of six patients died. The characteristics of hepatocellular carcinoma in the caudate lobe were as follows: (a) a higher surgical risk, and more definite risk in the paracaval portion; and (b) a higher rate of early recurrence. A left lobectomy for the Spiegel lobe, a right or left trisegmentectomy for the paracaval portion and a right lobectomy for the caudate process would be ideal from the point of view of the portal supply of the caudate lobe. However, in cirrhotic patients either a caudate lobectomy or partial resection might be preferable because longer survival can be expected. (HEPATOLOGY 1994;19:911–915.)