Parenchyma-sparing anatomical liver resection based on Hjortsjo’s concept

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• 作者：Satoshi Ogiso (1) (2)
  Iwao Ikai (1)
  Masato Narita (1)
  Takahide Murakami (1)
  Hiroaki Hata (1)
  Takashi Yamaguchi (1)
  Tetsushi Otani (1)
  
• 关键词：Liver resection ; Hjortsjo’s concept ; Parenchyma ; sparing resection ; Venous drainage ; Venous congestion
• 刊名：Langenbeck's Archives of Surgery
• 出版年：2013
• 出版时间：June 2013
• 年：2013
• 卷：398
• 期：5
• 页码：751-758
• 全文大小：362KB
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• 作者单位：Satoshi Ogiso (1) (2)
  Iwao Ikai (1)
  Masato Narita (1)
  Takahide Murakami (1)
  Hiroaki Hata (1)
  Takashi Yamaguchi (1)
  Tetsushi Otani (1)
  
  1. Department of Surgery, Kyoto Medical Center, Kyoto, Japan
  2. Division of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
  
• ISSN：1435-2451

文摘

Purpose Anatomical liver resection is usually based on Couinaud’s anatomical concept. In contrast, Hjortsjo’s concept, which divides the right anterior section of the liver into ventral and dorsal segments by the vertical plane named the ventral segment fissure (VSF), has been rarely utilized for liver resection. Identification of the VSF is the most difficult step in liver resection based on Hjortsjo’s concept. This study aimed to detail liver resection based on Hjortsjo’s concept and report surgical outcomes of this procedure. Methods We reviewed the records of 166 consecutive patients who underwent liver resection between September 2009 and June 2012 at Kyoto Medical Center and identified seven liver resections in which Hjortsjo’s concept was utilized. These patients consisted of four men and three women aged 55-9?years. Four patients had hepatocellular carcinoma and cirrhosis and three patients had metachronous colorectal liver metastasis. Results Liver resection along the VSF consisted of two extended left medial sectionectomies, three extended right posterior sectionectomies, and one Sg 7+8-dorsal resection by a venous-drainage-guided approach and one Sg 8-dorsal resection by a Glissonian approach. In all patients, the VSF was successfully identified as a congested or ischemic border on the liver surface. Mortality and major morbidity were nil. No patients underwent blood transfusion. After a median follow-up of 15?months, there were no deaths or local recurrence. Conclusions Anatomical liver resection based on Hjortsjo’s concept is feasible and advantageous over conventional liver resection because it preserves more parenchyma. The venous-drainage-guided approach is an effective method for identifying the VSF.