目的总结肝尾状叶海绵状血管瘤手术切除的指征及技巧。方法对我科2005年9月至2010年9月期间开展的8例肝尾状叶海绵状血管瘤切除病例的临床资料进行分析。结果全组患者均在无血流阻断下顺利完成手术，无手术死亡。术中出血量为1 000～5 000 ml，（2 500±800） ml; 手术时间为3～6 h，(4.2±0.8） h。1例肝硬变患者术后1 d即出现腹水，经积极治疗后得以控制。3例患者术后1周发现右侧胸腔积液，经1～2次胸腔穿刺抽液后治愈。1例患者术后1周出现不全性肠梗阻，经保守治疗1周后痊愈。术后应用B超每半年复查肝脏情况，随访0.5～5年，（2.5±1.2）年，1例失访，1例患者死于心肌梗死，余均存活，仍在随访中。所有病例均未复发。结论肝尾状叶海绵状血管瘤手术应充分显露、精准操作，彻底切除肿瘤，避免大出血和空气栓塞，减少和防止残肝的热缺血再灌注损伤。
【摘要】 目的 探讨治疗肝尾状叶巨大海绵状血管瘤的外科手术方法。方法 通过1 例肝尾状叶巨大海绵状血管瘤外科手术治疗体会并结合文献复习,分析肝尾状叶解剖及影像学特点,探讨外科手术方法。结果 肝尾状叶巨大海绵状血管瘤因肝尾状叶特殊的解剖特点,安全并有效的肝全尾叶血管瘤切除是治疗这类疾病的有效治疗方法。结论 选择合适的手术径路是关键,熟练并精细地解剖、默契的手术配合可以安全切除肝尾状叶巨大海绵状血管瘤。
ObjectiveTo review the clinical experience and evaluate the results in patients who underwent caudate lobectomy for malignant tumor at caudate lobe of liver. MethodsClinicopathological characteristics of 51 patients who underwent caudate lobectomy because of malignant tumors at caudate lobe of liver in our hospital from May 2007 to December 2013 were reviewed retrospectively, and operative detail, complication rate, and survival rate were described. ResultsThe cancer were resected successfully in 51 patients with malignant tumors at caudate lobe of liver. Thirty patients were performed isolated caudate lobectomy and 21 patients performed combined lobectomy. Of the 51 patients, 9 patients were treated with retrograde caudate lobectomy. The operation time was 180.0-360.0 min, with the average value of 244.0 min. The bleeding volume was 400.0-1 000.0 mL, with the average value of 630.0 mL. In all patients, there was no perioperative death and no postoperative bleeding happened, and 17 patients who suffered from interrelated complications were cured or got better by conservative treatments. Fifty-one patients were followed up for 6-60 months, and the median survival time was 38.0 months. During the follow-up period, 29 patients dead, 21 patients suffered from recurrence, and 12 patients suffered from metastasis. The cumulative survival rates of 1-, 3-, and 5-year were 76.1%, 54.7%, and 31.8% respectively after caudate lobectomy. ConclusionThe caudate lobectomy in treatment of malignant tumor at caudate lobe of liver is effective and feasible.
The caudate lobe of the liver has always been regarded as the deepest segment, with most complicated anatomy. The surgeon’s understanding of the caudate lobe and its subsegments has undergone a complex and tortuous process. In recent years, the special view and fine anatomy of the caudate lobe in laparoscopic resection of caudate lobe of liver have been proved or challenged based on the traditional anatomical knowledge of the liver gross specimen, cast specimen and three-dimensional reconstruction. It is these validations and challenges that keep surgeons revising and restoring the caudate anatomy to its true form. This article will discuss these new ideas and describe the laparoscopic total caudate lobectomy in detail from the point of view of a laparoscopic surgeon.