Hepatic trisectionectomy for liver neoplasm: a report of 60 cases

HUANG Liang; LIU Cai-feng; ZHOU Fei-guo; YAN Jian-jun; WU Meng-chao; YAN Yi-qun

doi:10.3321/j.issn:1005-2208.2009.11.017

Abstract：Objective To investigate the surgical technique of hepatic trisectionectomy. Methods The clinical data of 60 patients performed hepatic trisectionectomy between January 2000 and December 2005 at the Eastern Hepatobiliary Hospital of Second Military Medical University were analysed retrospectively. Results Liver function classification were Child-Pugh A in all patients. Among them, 57 patients (95%) were score 5 and 3 patients (5%) score 6. Average diameter of tumor was 15.2cm (range 5-27cm). Among them, diameters of 34 patients (56.7%). were not less than 15cm, and those of 12 patients (20% ) were not less than 20cm. Left trisectionectomy was performed in 24 patients, and right trisectionectomy was performed in 36 patients. Added caudatectomy was performed in 1 patient, and portal vein thrombosis extraction was performed in 3 patients. Vena cava thrombosis extraction plus right adrenal grand resection was performed in 1 patient. Exploration and extraction for thrombus in common bile duct was perfomed in 2 patients, and lymphadenectomy was performed in 4 patients. Hepatic resection was performed clamping of the hepatic pedicle at room temperature in all patients. The longest of total clamping period and single clamping were 73 minutes and 45 minutes, and the average were 30.1 minutes. The maximum of blood transfusion and average blood transfusion were 13 200 mL and 2003 mL, and no transfusion needed in 15 patients. Postoperative complications occurred in 8 patients (13.3%), and 2 of the 60 patients (3.3% )died. Conclusion Hepatic trisectionectomy is an effect surgical therapy for liver neoplasm. To reduce postoperative complications, proper evaluation of liver reserve capacity before operation, good exposure in operation, well management of hepatic wound, and kind protection of vital structure are essential.