The significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the feasibility of developing a tunnel between inferior vena cava (IVC) and caudate lobe before passing a tape through it, and to explore the significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy.</p><p><b>METHODS</b>Blunt dissection was used to develop the tunnel before a tape was passed through. A hemostatic plate was placed on the surface of liver parenchyma if needed. In the procedure of hepatectomy, the tape was pulled up to create an interspace between liver parenchyma and IVC so that the IVC can be protected during transection.</p><p><b>RESULTS</b>Liver hanging maneuver was performed successfully in 47 cases. There were no severe complications related to the procedure in these cases. The procedure was terminated in 1 case because of severe bleeding.</p><p><b>CONCLUSIONS</b>1. Liver hanging maneuver is feasible in terms of anatomy and technique. 2. With liver hanging maneuver, IVC can be protected safely and the intrahepatic vessels and ductal system at the transaction line can be exposed clearly. It also makes anterior approach for hepatectomy safer and easier.</p>

Retrograde caudate lobectomy in 7 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical value and significance of retrograde caudate lobectomy.</p><p><b>METHODS</b>From December 2003 to January 2005, 7 patients underwent retrograde caudate lobectomy in which division and ligation of short hepatic veins were carried out at the final stage of the procedure in stead of at the initial stage.</p><p><b>RESULTS</b>The procedures were carried out smoothly with no operative death in all the 7 cases including isolated complete caudate lobectomy in 4 cases, isolated partial caudate lobectomy in 1 case, combined right half liver resection in 2 case. The average operation time, blood loss and length of stay after operation was (273 +/- 44) min, (1114 +/- 241) ml (800-1500 ml) and 16 days respectively. Complications including pleural effusion and ascites in 1 case respectively were fully recovered. During the follow-up, 1 patient died at 6 months for tumor recurrence in lung and the remaining 6 patients are alive at the follow-up of 5 to 16 months.</p><p><b>CONCLUSIONS</b>Retrograde caudate lobectomy is a new procedure suitable for those caudate neoplasms which are adhering to or infiltrating to IVC or too big to move side by side. The application of this technique can converse certain kind of caudate lobe tumor from non-resectable to resectable resulting in widening the indication.</p>

Surgical treatment of hepatocellular carcinoma originating from caudate lobe / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the significance of surgical treatment of HCC originating from caudate lobe.</p><p><b>METHODS</b>From 1995 to 2003, caudate lobectomy, including 19 cases of isolated lobectomy and 20 cases of combined lobectomy, were performed in 39 patients with HCC originating from caudate lobe, and the factors that might influence postoperative liver function were compared between the two groups.</p><p><b>RESULTS</b>All tumors were resected successfully. One patient died of postoperative renal failure. Hydrothorax occurred in 3 patients, ascites in 4 patients, and bile leakage in 1 patient. The survival rates of 1, 3, 5 year were 53%, 50%, 39% respectively.</p><p><b>CONCLUSIONS</b>Caudate lobectomy is a effective method for HCC originating from caudate lobe.</p>