9 Cases’ Clinical Analysis Of Laparoscopic Resection Of Hepatic Caudate Tumors

Background:Liver caudate lobe is located at the central back of liver,of which the regional anatomy is complex.The surgical treatment of the lesions in this area has been the difficulty of hepatobiliary surgery.With research developing in depth,the cases of laparotomy of caudate lobe tumor are reported increasingly and the treatment strategy has gradually reached an agreement.Nowadays laparoscopic surgical technique is used in clinic widely because of many advantages such as its small trauma,beautiful healing of incision,postoperative rapid recovery of patients,fewer complications and so on.However,the current cases of laparoscopic caudate lobe resection are reported very little.It has not reached standards surgery treatment due to lack of experience.This article discusses the laparoscopic resection of the caudate tumor to sum up experience and to guide the clinical therapy in the future.Objective:to discuss preoperative diagnosis,method,approach,the security,feasibility and experience of laparoscopic resection of hepatic caudate tumors.Methods:9 cases of laparoscopic resections of hepatic caudate tumors were carried out from June,2015 to November,2016.To analyze the clinical data from the aspects of preoperative diagnosis,surgical approach,operation method and postoperative recovery,etc.Results:9 cases were all operated by the liver surgery professors and completed smoothly.The tumors were totally resected and none of operations were converted to laparotomy.Duration of operation was from 75 min to 285min(mean,127.2 min).Intraoperative blood loss was from 50 to 350 mL(mean,133.3 mL).None of the patients were received intraoperative blood transfusion.In 4 cases the first hepatic portal area was blocked,of which 3 cases blocking time were respectively 21 min,20 min,15 min.Among 9 cases,2 cases were operated in right approach,4 cases were operated in combine approach and 3 cases were operated in left approach.In none of these cases the first hepatic portal area,the second hepatic portal area and the inferior vena cava were damaged and no complications such as bleeding occurred.Postoperative pathological results tip that 4 cases were liver hemangioma,4 cases were primary liver cancer,1 case was hepatic focal nodular hyperplasia.The time of postoperative hospital stay was from 6 to 14 days(mean,8.2 days).In 1 case of the patient with primary liver cancer there appeared yellow-green bile liquid in the abdominal cavity drainage tube,indicating bile leakage from surgical wound of the liver.The patient carried abdominal cavity drainage tube and the bile leakage was healed 2 months after discharging.The rest of the patients were recovered smoothly after the operation,without serious complications and they were received treatment of anti-inflammation and protecting liver,acid suppression,nutrition support until they discharged.The cost of the 9 cases was from 38241.35 yuan to 82452 yuan and t the average cost was 55464.83 yuan.Conclusions:Liver caudate lobe tumors generally are characterized by the abdomen or upper abdominal pain,abdominal distention,discomfort after eating.The tumor of some patients can be asymptomatic,only found by physical examination.B ultrasonic and abdominal CT and MRI are of great significance to the preoperative diagnosis of caudate lobe tumor and to the selection of surgical method and approach.Due to the regional anatomy of the caudate lobe is complex,the right approach and operation method of laparoscopic resection of caudate lobe tumors should be chosen according to the tumor’s location,size and relationship with the surrounding structures.Usually the right approach or combine approach is adapted to tumors in the right caudate lobe,and the left approach or combine approach is adapted to the tumor of left caudate lobe.The combine approach is used frequently in the clinical application.Laparoscopic resection of caudate lobe tumors is suitable for smaller lesions of caudate lobe which is confined to the caudate lobe tumor.If tumors are huge and invade other hepatic segments,or if there are tumors in other liver segment,the resection method should be combine resection of the certain segment.In the space between the inferior vena cava and caudate lobe,the short hepatic veins should be carefully searched,occluded and cut off one by one.The important blood vessels in the first porta hepatis and the second hepatic door should avoid damage.The occlusion bond could be preset in the first porta hepatis,in the case of surgical bleeding.Adequate examination and assessment of the conditions of the patients before surgery are necessary.Carried by the high qualification experienced surgeon,laparoscopic resection of liver caudate lobe tumor is safe and feasible,and the treatment effect is good,although the procedure is complicated.