探讨经肝右静脉离断并重建入路肝尾状叶肿瘤切除术安全性和疗效。

回顾性分析2017年11月西安交通大学第一附属医院1例肝尾状叶肿瘤切除术患者临床资料。患者女，54岁，术前诊断为肝尾状叶肝细胞癌。患者签署患者知情同意书，符合医学伦理学规定。采用新创的经肝右静脉离断并重建入路法实施肝尾状叶肿瘤切除术，优先处理肝短静脉，离断肝右静脉后切除尾状叶肿瘤，再重建肝右静脉。

手术顺利，术中阻断右半肝血流及肝下下腔静脉20 min，全肝血流阻断1次，时间15 min，术中出血量800 ml，输红细胞4 U。术后常规给予抗感染、抑酸、降低门静脉压力、护肝、营养支持治疗。术后7 d复查上腹部CT示肝右叶近肝门处斑片状低密度影，门静脉不宽，肝内胆管无扩张，胆囊窝少量积气积液。病理学检查结果示肝块状型中分化肝细胞癌伴局部囊性变。术后15 d恢复顺利出院。

与其他尾状叶手术方式相比，经肝右静脉离断并重建入路肝尾状叶肿瘤切除术创伤更小、出血量更少，是一种新的尾状叶切除入路，适用于累及腔静脉及尾状突的尾状叶肿瘤切除。

To evaluate the safety and clinical efficacy of resection of caudate lobe tumor via devascularization and reconstruction of right hepatic vein.

Clinical data of a patient who underwent resection of caudate lobe tumor in the First Affiliated Hospital of Xi'an Jiaotong University in November 2017 were retrospectively analyzed. The patient was female, 54-year-old, was diagnosed with hepatocellular carcinoma in the liver caudate lobe before operation. The informed consent of the patient was obtained and the local ethical committee approval was received. Resection of caudate lobe tumor was performed via a new approach, devascularization and reconstruction of the right hepatic vein. The short hepatic vein was treated preferentially. Devascularization of the right hepatic vein was performed, followed by resection of caudate lobe tumors and subsequently the right hepatic vein was reconstructed.

The operation was successfully accomplished. Blood flow of the right lobe and the inferior hepatic vena cava was excluded for 20 min. Total hepatic flow was occluded once for 15 min. The intraoperative blood loss was 800 ml, and 4 U of red blood cell transfusion was performed. Postoperative treatments anti-infection, acid suppression, lowering portal vein pressure, liver protection and nutritional support were routinely delivered. CT scan of the upper abdomen at postoperative 7 d indicated patchy low-density shadows in the right lobe near the hepatic porta, no expansion of the portal vein and intrahepatic bile duct, and a slight pneumatosis and hydrops in the gallbladder fossa. Pathological examination showed a bulky moderately-differentiated hepatocellular carcinoma combined with local cystic lesions. The patient recovered well and discharged at postoperative 15 d.

Compared with the conventional caudate lobectomy, devascularization and reconstruction of the right hepatic vein is a novel approach for caudate lobectomy with slighter trauma and less bleeding, which is suitable for the resection of caudate lobe tumor involving the vena cava and caudate process.