Subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe: a case report_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Can , LI Chuan ,  WEN Tianfu

Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WEN Tianfu, Email: wentianfu@scu.edu.cn

Keywords：

hepatolithiasis; subtotal hepatectomy; caudate lobe

DOI：

10.7507/1007-9424.202003072

Video：

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Objective To investigate the feasibility and safety of subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.Method The clinicopathologic data of patient with hepatolithiasis whose left and right hepatic lobe atrophied and caudate lobe obviously hypertrophied admitted to the West China Hospital of Sichuan University in February 2020 were analyzed retrospectively.Results The patient was in good general condition before the operation. The cardiopulmonary and kidney functions were normal. The liver function was Child-Pugh A grade, and the liver reserve function was good. The body surface area of the patient was 1.745 m² and the standard liver volume was 1 235 mL. The volume of caudate lobe calculated by the 3D reconstruction of CT image was 735 mL, accounted for 59.5% of the standard liver volume. The patient was evaluated to be able to tolerate the operation. The patient successfully experienced the operation of subtotal hepatectomy with caudate lobe preservation. The postoperative liver function recovered well. The gastric tube was removed on the 4th day after the operation. The peritoneal drainage tube was removed on the 5th day after the operation. The patient was discharged on the 6th day after the operation. The postoperative pathological diagnosis: The intrahepatic bile duct was dilated with stones inside. A large number of inflammatory cell infiltrated around the bile duct. The fibrous tissue hyperplasia, small bile duct hyperplasia and inflammatory cell infiltration were observed in the portal area. The pathological changes were consistent with the changes of hepatolithiasis.Conclusion According to analysis results of this case, subtotal hepatectomy with preservation of caudate lobe is safe and feasible for hepatolithiasis patient with obvious atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.

Citation： JIANG Can, LI Chuan, WEN Tianfu. Subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe: a case report. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 595-599. doi: 10.7507/1007-9424.202003072 Copy

1.	Kim HJ, Kim JS, Joo MK, et al. Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World J Gastroenterol, 2015, 21(48): 13418-13431.
2.	段炼, 李宜雄. 肝胆管结石发病机制的研究进展. 国外医学(外科学分册), 2005, 32(4): 255-260.
3.	Shoda J, Tanaka N, Osuga T. Hepatolithiasis-epidemiology and pathogenesis update. Front Biosci, 2003, 8: e398-e409.
4.	Tsui WM, Chan YK, Wong CT, et al. Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis, 2011, 31(1): 33-48.
5.	Fan ST, Wong J. Complications of hepatolithiasis. J Gastroenterol Hepatol, 1992, 7(3): 324-327.
6.	黄志强. 肝内胆管结石手术方法的选择. 中国实用外科杂志, 1994, 14(3): 136-137.
7.	Yang T, Lau WY, Lai EC, et al. Hepatectomy for bilateral primary hepatolithiasis: a cohort study. Ann Surg, 2010, 251(1): 84-90.
8.	Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition, 1989, 5(5): 303-311.
9.	Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology, 1995, 21(5): 1317-1321.
10.	董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011 版). 中华消化外科杂志, 2011, 10(1): 20-25.
11.	Su CH, Lui WY, P'eng FK. Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study. Dig Dis Sci, 1992, 37(5): 764-768.
12.	Nakayama F, Furusawa T, Nakama T. Hepatolithiasis in Japan: present status. Am J Surg, 1980, 139(2): 216-219.
13.	Park YH, Park SJ, Jang JY, et al. Changing patterns of gallstone disease in Korea. World J Surg, 2004, 28(2): 206-210.
14.	吴华帅, 俞渊, 陈金梅. 肝内胆管结石的外科治疗. 医学信息, 2020, 33(1): 24-27.
15.	Murakami G, Hata F. Human liver caudate lobe and liver segment. Anat Sci Int, 2002, 77(4): 211-224.
16.	牛朝诗, 耿小平, 韩卉, 等. 肝尾状叶的应用解剖研究. 肝胆外科杂志, 1997, 5(5): 310-313.
17.	Ortale JR, Borges Keiralla LC. Anatomy of the portal branches and the hepatic veins in the caudate lobe of the liver. Surg Radiol Anat, 2004, 26(5): 384-391.
18.	Miyayama S, Yamashiro M, Yoshie Y, et al. Hepatocellular carcinoma in the caudate lobe of the liver: variations of its feeding branches on arteriography. Jpn J Radiol, 2010, 28(8): 555-562.
19.	李志鹏, 曾兆林. 肝脏尾状叶的外科解剖及其增生. 中国普外基础与临床杂志, 2013, 20(9): 1065-1068.
20.	仇公才, 郑万仁, 李志鹏, 等. 肝尾状叶代偿功能的研究. 中华实验外科杂志, 2014, 31(10): 2151-2154.
21.	Shuto T, Kinoshita H, Yamada C, et al. Bilateral lobectomy excluding the caudate lobe for giant mesenchymal hamartoma of the liver. Surgery, 1993, 113(2): 215-222.
22.	Dong J, Lau WY, Lu W, et al. Caudate lobe-sparing subtotal hepatectomy for primary hepatolithiasis. Br J Surg, 2012, 99(10): 1423-1428.
23.	Li AJ, Yang JM, Tang QH, et al. Caudate lobe as the sole remnant liver following extended liver resection for hepatocellular carcinoma. Int J Surg Case Rep, 2014, 5(8): 462-464.
24.	彭创, 李佳, 易为民, 等. 单独保留肝尾状叶解剖性肝切除治疗肝胆管结石病. 中华消化外科杂志, 2016, 15(1): 81-84.
25.	柴乃俊, 蒋泽斌, 赵慧琪, 等. 保留尾状叶肝次全切除治疗肝内胆管结石病. 中国普外基础与临床杂志, 2018, 25(2): 207-212.

1. Kim HJ, Kim JS, Joo MK, et al. Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World J Gastroenterol, 2015, 21(48): 13418-13431.
2. 段炼, 李宜雄. 肝胆管结石发病机制的研究进展. 国外医学(外科学分册), 2005, 32(4): 255-260.
3. Shoda J, Tanaka N, Osuga T. Hepatolithiasis-epidemiology and pathogenesis update. Front Biosci, 2003, 8: e398-e409.
4. Tsui WM, Chan YK, Wong CT, et al. Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis, 2011, 31(1): 33-48.
5. Fan ST, Wong J. Complications of hepatolithiasis. J Gastroenterol Hepatol, 1992, 7(3): 324-327.
6. 黄志强. 肝内胆管结石手术方法的选择. 中国实用外科杂志, 1994, 14(3): 136-137.
7. Yang T, Lau WY, Lai EC, et al. Hepatectomy for bilateral primary hepatolithiasis: a cohort study. Ann Surg, 2010, 251(1): 84-90.
8. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition, 1989, 5(5): 303-311.
9. Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology, 1995, 21(5): 1317-1321.
10. 董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011 版). 中华消化外科杂志, 2011, 10(1): 20-25.
11. Su CH, Lui WY, P'eng FK. Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study. Dig Dis Sci, 1992, 37(5): 764-768.
12. Nakayama F, Furusawa T, Nakama T. Hepatolithiasis in Japan: present status. Am J Surg, 1980, 139(2): 216-219.
13. Park YH, Park SJ, Jang JY, et al. Changing patterns of gallstone disease in Korea. World J Surg, 2004, 28(2): 206-210.
14. 吴华帅, 俞渊, 陈金梅. 肝内胆管结石的外科治疗. 医学信息, 2020, 33(1): 24-27.
15. Murakami G, Hata F. Human liver caudate lobe and liver segment. Anat Sci Int, 2002, 77(4): 211-224.
16. 牛朝诗, 耿小平, 韩卉, 等. 肝尾状叶的应用解剖研究. 肝胆外科杂志, 1997, 5(5): 310-313.
17. Ortale JR, Borges Keiralla LC. Anatomy of the portal branches and the hepatic veins in the caudate lobe of the liver. Surg Radiol Anat, 2004, 26(5): 384-391.
18. Miyayama S, Yamashiro M, Yoshie Y, et al. Hepatocellular carcinoma in the caudate lobe of the liver: variations of its feeding branches on arteriography. Jpn J Radiol, 2010, 28(8): 555-562.
19. 李志鹏, 曾兆林. 肝脏尾状叶的外科解剖及其增生. 中国普外基础与临床杂志, 2013, 20(9): 1065-1068.
20. 仇公才, 郑万仁, 李志鹏, 等. 肝尾状叶代偿功能的研究. 中华实验外科杂志, 2014, 31(10): 2151-2154.
21. Shuto T, Kinoshita H, Yamada C, et al. Bilateral lobectomy excluding the caudate lobe for giant mesenchymal hamartoma of the liver. Surgery, 1993, 113(2): 215-222.
22. Dong J, Lau WY, Lu W, et al. Caudate lobe-sparing subtotal hepatectomy for primary hepatolithiasis. Br J Surg, 2012, 99(10): 1423-1428.
23. Li AJ, Yang JM, Tang QH, et al. Caudate lobe as the sole remnant liver following extended liver resection for hepatocellular carcinoma. Int J Surg Case Rep, 2014, 5(8): 462-464.
24. 彭创, 李佳, 易为民, 等. 单独保留肝尾状叶解剖性肝切除治疗肝胆管结石病. 中华消化外科杂志, 2016, 15(1): 81-84.
25. 柴乃俊, 蒋泽斌, 赵慧琪, 等. 保留尾状叶肝次全切除治疗肝内胆管结石病. 中国普外基础与临床杂志, 2018, 25(2): 207-212.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe: a case report

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