目的 探讨肝尾状叶巨大肿瘤的手术疗效及最佳手术方法.方法 对2001年1月至2007年6月,东方肝胆外科医院手术治疗的33例肝尾状叶巨大肿瘤(≥10 cm)患者资料进行回顾性分析.对单独尾状叶切除与联合切除病例的临床病理特征、手术结果、并发症、远期生存率进行比较.结果 33例患者中15例(45.5％)接受了全部或部分尾状叶切除,18例(54.5％)接受了全部或部分尾状叶切除联合部分肝切除.手术切除最常用于原发性肝癌(HCC)(51.5％)、其次为血管瘤(21.2％)、肝内胆管癌(9.1％)、血管平滑肌脂肪瘤(6.1％)、肝腺瘤(3％)、局灶性结节性增生(3％)、结肠癌肝转移(3％)和肉瘤(3％).肿瘤的平均直径为12.3(范围10.2～21)cm.与联合肝尾状叶切除术比较,单纯尾状叶切除患者有较长的手术时间(280 min比170 min)及住院天数(17 d比12 d),失血量较多(1250ml比670 ml).两组病例均无围手术期死亡.单纯肝尾状叶切除术与联合肝尾状叶切除术两组患者的并发症发生率为别为26.7％与16.7％.恶性病变组患者1、3、5年无瘤生存率,单纯肝尾状叶切除术组分别为25.9％、0％、0％,联合肝尾状叶切除术组为74.3％、46.7％、31.2％.两组恶性病变患者的总生存率分别为68.6％、19.7％、0％和100％、66.5％、41.8％.结论 肝尾状巨大肿瘤切除术的术式取决于病变的大小、位置及肝脏的功能储备.肝功能储备良好的病例,肝尾状叶切除联合其他部分肝切除是首选.而对于肝功能储备处于临者值的患者,惟一可行的术式是单纯的肝尾状叶切除术.%Objective To evaluate the optimal surgical approach for huge liver neopiasms in the caudate lobe.Methods Thirty-three patients with huge liver neplasms（≥10cm) underwent caudate lobectomy at a single tertiary referral center between January 2001 and June 2007.The surgical out-comes of pateints who underwent isolated caudate lobectomy or caudate lobectomy combined with partial hepatectomy were compared.Result Fifteen（45.5％）of 33 patients underwent isolated total or partial caudate lobectomy（group A）,whereas 18（54.5％) had total or partial caudate lobectomy cellular carcinoma (HCC) (51.5％),followed by hemangioma(21.2％),intrahepatic cholangiocarcinoma(9.1％),angiomyolipoma(6.1％),hepatic adenoma (3％),focal nodular hyperplasia(3％),colorectal liver metastases(3％)and sarcoma(3％).The median diameter of the tumour was 12.3 (range,10.2-21)cm.Patients in group A had significantly longer operative time (280 minutes vs.170 minutes),longer length of hospital stay (17 days vs.12 days)and more blood loss(1250 ml vs.670 ml) than patients in group B.There was no perioperative death in the 2 groups of pateints.Complication rates in group A and group B were 26.7％ and 16.7％ respectively.There was no disease-related death in patients with benign lesions.The1-,3- and 5-year disease-free survivals of patients with malignant lesions in group A and group B were 25.9％,0％,0％and 74.3％,46.7％,31.2％,respectively.The 1-,3- and 5-year overrall survivals were 68.6％,19.7％,0％ and 100％,66.5％,41.8％,respecively.Conclusion The approach to caudate lobectomy depends on the size and location of the lesion and the liver functional reserve.For patients with sufficient liver functional reserve,caudate lobectomy combined with partial hepatectomy is preferred because it is technically less demanding.For patienls with marginal liver functional reserve,isolated caudate lobectomy is the only viable surgical option.
展开▼
