title: [Clinical experiences of surgical manipulations for hepatic masses in difficult sites].
abstract: OBJECTIVE
  To summarize the surgical experiences, risks, complications, and managements for hepatic masses in difficult sites.
  
  
  METHODS
  Totally 47 patients were divided into three groups based on the liver tumor sites: primary porta hepatis group, secondary porta hepatis group, and caudate lobe group. All patients underwent different portion of hepatectomy.
  
  
  RESULTS
  The surgery duration was (289.6 +/- 62.2) ml-nutes, intra-operative blood loss was (602.3 +/- 256.4) ml, and intra-operative blood transfusion was (524.0 +/- 325.9) ml. Incidence of surgical complications in each group was 61.5%, 26.9%, and 25%, respectively. Serious complications observed were biliary leakage (27.7%), bleeding (6.4%), and post-operative liver failure (2.1%). Three perioperative deaths were reported: two patients died of bleeding, and one patient died from liver failure.
  
  
  CONCLUSIONS
  Dissection of the liver and exposure of major blood vessels and biliary ducts are of critical importance in the surgeries for hepatic masses in difficult sites, and post-operative complications may be remarkably reduced through delicate manipulations of the small intra-hepatic vessels and biliary ducts during resection. A thorough pre-operative evaluation plays a key role in predicting the feasibility and risks of the surgery. Damage to the major blood vessels adjacent to the tumor, in addition to bleeding, may result in in-flow or outflow obstruction and cause necrosis of the corresponding hepatic lobe. Compared with damage to the primary portal area, vascular damage to the secondary porta is generally associated with higher fatality.
authors.affiliation: Department of Liver Surgery, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
authors.forename: Xin-ting
authors.initials: XT
authors.lastname: Sang
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.forename: Yi-lei
authors.initials: YL
authors.lastname: Mao
authors.forename: Hai-tao
authors.initials: HT
authors.lastname: Zhao
authors.forename: Yi-yao
authors.initials: YY
authors.lastname: Xu
authors.forename: Shun-da
authors.initials: SD
authors.lastname: Du
authors.forename: Hai-feng
authors.initials: HF
authors.lastname: Xu
authors.forename: Tian-yi
authors.initials: TY
authors.lastname: Chi
authors.forename: Zhi-ying
authors.initials: ZY
authors.lastname: Yang
authors.forename: Shou-xian
authors.initials: SX
authors.lastname: Zhong
authors.forename: Jie-fu
authors.initials: JF
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care