Precise Liver Resection for Giant Complex Hepatic Neoplasm: Report of 52 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHAI Tianqiao ^1,2 , JIN Shuguang ¹ , CHEN Zheyu. ¹

1.Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;;
2.Department of General Surgery, Chaotian District People’s Hospital of Guangyuan City, Guanyuan 628012, Sichuan Province, China;

Corresponding author：

Keywords：

Liver resection; Hepatic neoplasm; Hepatic blood occlusion; Intraoperative ultrasonography; Hepatic functional reserve

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ObjectiveTo summarize the experiences of precise liver resection for giant complex hepatic neoplasm. MethodsFifty-two cases of giant complex hepatic neoplasms were resected using precise liver resection techniques from April 2008 to August 2009. Hepatic functional reserve and liver imaging were evaluated before operation. Appropriate surgical approach, halfhepatic blood flow occlusion, new technique of liver resection, and intraoperative ultrasonography were applied during operation. ResultsThe mean operative time, halfhepatic blood occlusion time, blood loss, recovery of alanine aminotransferase, and total bilirubin were 350 min (210－440 min), 43 min (8－57 min), 370 ml (250－1 150 ml), 10 d (7－14 d), and 4.5 d (3－10 d), respectively. Only 6 patients had mild bile leakage. No liver failure and other major complications emerged, and no death happened. ConclusionPrecise liver resection is a safe and effective approach for giant complex hepatic neoplasm.

Citation： CHAI Tianqiao,JIN Shuguang,CHEN Zheyu.. Precise Liver Resection for Giant Complex Hepatic Neoplasm: Report of 52 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(9): 952-955. doi: Copy

1.	Sotiropoulos GC, Lang H, Frilling A, et al. Resectability of hepatocellular carcinoma: evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature [J]. Hepatogastroenterology, 2006, 53(69): 322329.
2.	严律南, 陈晓理, 李志辉, 等. 肝癌肝切除术围手术期处理的临床研究(附2 143例报告) [J]. 中国普外基础与临床杂志, 2005, 12（2）: 162166.
3.	杜正贵, 李波, 冯曦, 等. 脉搏染料光密度法吲哚氰绿排泄试验对评价肝癌切除术后肝功能不全的价值 [J]. 中国普外基础与临床杂志, 2009, 16（2）: 133136.
4.	劳向明, 张亚奇, 林小军, 等. 吲哚靛青绿储留率判断切肝量及其与肝癌术后肝功能不全的关系 [J]. 癌症, 2005, 24（3）: 337340.
5.	Lau H, Man K, Fan ST, et al. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy [Ｊ]. Br J Surg, 1997, 84(9): 12551259.
6.	Hemming AW, Scudamore CH, Shackleton CR, et al. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients [Ｊ]. Am J Surg, 1992, 163(5): 515518.
7.	Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [Ｊ]. Surg Gynecol Obstet, 1987, 164(2): 155158.
8.	文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008, 15（4）: 299302.
9.	陆森, 黄新立, 李相成, 等. 吲哚氰绿清除试验在半肝切除术中应用的价值 [J]. 中国普外基础与临床杂志, 2010, 17（6）: 543546.
10.	Liu CL, Fan ST, Lo CM, et al. Anterior approach for major right hepatic resection for large hepatocellular carcinoma [J]. Ann Surg, 2000, 232(1): 2531.
11.	Azoulay D, Marinhargreaves G, Castaing D, et al. The anterior approach: the right way for right massive hepatectomy [J]. J Am Coll Surg, 2001, 192(3): 412417.
12.	耿小平. 前入路肝切除术 [J]. 临床外科杂志, 2009,17(9): 586588.
13.	Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization [J]. J Am Coll Surg, 2001, 193(1): 109111.
14.	李晓航, 张佳林, 王学梅, 等. 术中超声在肝胰肿瘤手术中的应用 [J]. 中国医科大学学报, 2009, 38（5）: 355356.
15.	宋宣, 刘连新, 姜洪池. 术中超声-微创观念在肝脏肿瘤手术中的应用[J]. 世界华人消化杂志, 2007, 15（23）: 25492552.
16.	温浩, 张金辉, 曹峻. 螺旋水刀和超声刀在肝叶切除术中的应用 [J]. 肝胆外科杂志, 2005, 13（6）: 410411.
17.	陈钟, 常仁安, 唐伟东. 新型超声刀在腹部开放手术中的应用体会 [J]. 中国现代手术学杂志, 2009, 13（4）: 257260.
18.	Une Y, Uchino J, Shimamura T, et al. Water jet scaplel for liver resection in hepatoceiiular carcinoma whh or without cirrhosis [J]. Int Surg, 1996, 81(1): 4548．.
19.	Nakayama H, Masuda H, Shibata M, et al. Incidence of bile leakage after three types of hepatic parenchymal transection [J]. Hepatogastroenterology, 2003, 50(53): 15171520.

1. Sotiropoulos GC, Lang H, Frilling A, et al. Resectability of hepatocellular carcinoma: evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature [J]. Hepatogastroenterology, 2006, 53(69): 322329.
2. 严律南, 陈晓理, 李志辉, 等. 肝癌肝切除术围手术期处理的临床研究(附2 143例报告) [J]. 中国普外基础与临床杂志, 2005, 12（2）: 162166.
3. 杜正贵, 李波, 冯曦, 等. 脉搏染料光密度法吲哚氰绿排泄试验对评价肝癌切除术后肝功能不全的价值 [J]. 中国普外基础与临床杂志, 2009, 16（2）: 133136.
4. 劳向明, 张亚奇, 林小军, 等. 吲哚靛青绿储留率判断切肝量及其与肝癌术后肝功能不全的关系 [J]. 癌症, 2005, 24（3）: 337340.
5. Lau H, Man K, Fan ST, et al. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy [Ｊ]. Br J Surg, 1997, 84(9): 12551259.
6. Hemming AW, Scudamore CH, Shackleton CR, et al. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients [Ｊ]. Am J Surg, 1992, 163(5): 515518.
7. Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [Ｊ]. Surg Gynecol Obstet, 1987, 164(2): 155158.
8. 文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008, 15（4）: 299302.
9. 陆森, 黄新立, 李相成, 等. 吲哚氰绿清除试验在半肝切除术中应用的价值 [J]. 中国普外基础与临床杂志, 2010, 17（6）: 543546.
10. Liu CL, Fan ST, Lo CM, et al. Anterior approach for major right hepatic resection for large hepatocellular carcinoma [J]. Ann Surg, 2000, 232(1): 2531.
11. Azoulay D, Marinhargreaves G, Castaing D, et al. The anterior approach: the right way for right massive hepatectomy [J]. J Am Coll Surg, 2001, 192(3): 412417.
12. 耿小平. 前入路肝切除术 [J]. 临床外科杂志, 2009,17(9): 586588.
13. Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization [J]. J Am Coll Surg, 2001, 193(1): 109111.
14. 李晓航, 张佳林, 王学梅, 等. 术中超声在肝胰肿瘤手术中的应用 [J]. 中国医科大学学报, 2009, 38（5）: 355356.
15. 宋宣, 刘连新, 姜洪池. 术中超声-微创观念在肝脏肿瘤手术中的应用[J]. 世界华人消化杂志, 2007, 15（23）: 25492552.
16. 温浩, 张金辉, 曹峻. 螺旋水刀和超声刀在肝叶切除术中的应用 [J]. 肝胆外科杂志, 2005, 13（6）: 410411.
17. 陈钟, 常仁安, 唐伟东. 新型超声刀在腹部开放手术中的应用体会 [J]. 中国现代手术学杂志, 2009, 13（4）: 257260.
18. Une Y, Uchino J, Shimamura T, et al. Water jet scaplel for liver resection in hepatoceiiular carcinoma whh or without cirrhosis [J]. Int Surg, 1996, 81(1): 4548．.
19. Nakayama H, Masuda H, Shibata M, et al. Incidence of bile leakage after three types of hepatic parenchymal transection [J]. Hepatogastroenterology, 2003, 50(53): 15171520.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Precise Liver Resection for Giant Complex Hepatic Neoplasm: Report of 52 Cases

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