Prevention and treatment of middle and left hepatic venous injury during hepatic subsegment IVa for hepatic cancer

Objective To investigate the prevention and treatment of middle and left hepatic venous injury during the resection of tumors in hepatic subsegment Ⅳa. Methods The clinical data of middle and left hepatic venous injury during the resection of tumors in hepatic subsegment Ⅳa for 47 cases from August 1996 to December 2008 were retrospectively analyzed. All cases were received resection successfully, including local excision of tumors in hepatic subsegment Ⅳa(12 cases), hepatic segmentectomy for subsegment Ⅳ (hepatectomy in left medial lobe, 10 cases), hepatectomy in left half(25 cases). Results The middle hepatic vein and/or left hepatic vein of 47 cases were performed during operation. Twenty-seven cases were received left hepatic venous ligation simultaneously or respectively. Eight cases were received left hepatic venous repairing. Four cases were received middle hepatic venous ligation. Six cases were received middle hepatic venous repairing. Coincidence of middle and left hepatic venous injury was 97.2%(35/36). Postoperative complications rate was 10.6%(5/47), reoperation owing to active bleeding(1 case), bile fistula combined with subphrenic infection(2 cases) and liver function incompensation (2 cases). No case died during operation. Conclusions Hepatic segmentectomy for subsegment Ⅳa is safe. Prevention and treatment of middle and left hepatic venous injury need to be emphasized on. The middle hepatic vein and left hepatic vein should be restored, after judged by preoperative CT or MRI. Key words: Liver neoplasma; Hepatectomy; Injury of hepatic vein; Hepatic segment; Prevention; treatment