ABSTRACT
Objective To study the feasibility and safety of laparoscopic hepatic caudate lobe resec tion.Methods The clinical data of seven patients who underwent laparoscopic hepatic caudate lobe resection in our hospital were retrospective analyzed.There were 3 male and 4 female patients.The mean age was 45.3 years.The primary diseases included hepatic haemangioma (n =2),metastatic liver cancer (n =2),hepatocellular carcinoma (n =1),recurrent hepatocellular carcinoma (n =1) and hepatic adenoma (n =1).The total blood loss,operation time,hospital stay after surgery and complication were analyzed.Results The surgery was successful in all these 7 patients and no patients required any conversion to open surgery.Five patients underwent partial caudate lobe resection,and the remaining 2 underwent combined left hemi hepatectomy with partial caudate lobe resection.The operation time ranged from 200 to 250 minutes with a mean of 235 minutes.The intraoperative blood loss ranged from 40 to 600 ml with a mean of 188 ml.There was no postoperative bleeding and bile leakage.The resections were all R0 resections.Conclusions Laparoscopic hepatic caudate lobe resection was safe and feasible in appropriate patients.Familiarity with anatomy of the liver caudate lobe and skilled laparoscopic techniques are important to carry out this surgery.
ABSTRACT
Objective: To summarize our experience on surgical treatment of caudate hepatolithiasis, so as to improve the diagnosis and treatment of caudate hepatolithasis. Methods: The clinical data, mode of operation, post-operation complications, and follow up findings were retrospectively analyzed in 19 patients with caudate hepatolithasis from Jan. 2000 to Dec. 2006. Results: The 19 cases included 8 males and 11 females. Totally they had undergone 30 times of operation, with 12 cases only had once, 4 had twice, 2 had thrice, and 1 had 4 times. All cases received B ultrasound, CT, MRCP or ERCP and were confirmed to have caudate hepatolithiasis. Fourteen cases were complicated with opening stonosis of caudate bile duct. Eleven cases received caudate lobe resection. Eight cases received caudate expansion of the bile duct or plastic repair of duct + caudate duct exploration and calculus extraction, with a success rate of 100% and the patients were stone free after surgery. Eighteen patients (94.7%) were followed up for a mean of (17.6±2.3) months. Two cases had stone recurrence. The excellent and good rate was 88.9% in the present cohort; all those who received resection of the caudate lobe had excellent or good outcomes. Conclusion: It is very complex and difficult to treat caudate bile duct stone; caudate duct exploration and calculus extraction usually have unsatisfactory outcomes. Caudate lobe resection can clear the lesions and has a good long-term effect, which is largely dependent on the rich experience and the skillfulness of the surgeons.