A Study of Preoperative Segmental Diagnosis of Hepatocellular Carcinoma

Satoshi Katagiri, Ken Takasaki, Masakazu Yamamoto and Takehito Otsubo

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University

Introduction: To achieve systematized hepatic resection using the glissonean sheath code transection for hepatic tumors, it is essential to identify the segment in which the tumors are localized. We studied the preoperative segmental diagnosis of hepatocellular carcinoma. Method: The correct preoperative segmental diagnosis rate was investigated in 111 cases with nodules of hepatocellular carcinoma by US, CT, angiography and portal angio-echo (PAE). The correct segmental diagnosis was determined on the basis of the intraoperative finding of systematized hepatic resection using the glissonean sheath code transection. We studied the accuracy of localization of hepatocellular carcinoma for the created three segments, the each image diagnosis and the misdiagnosis cases of PAE. Result: The correct preoperative segmental diagnosis was 90.1% for PAE, and it was differed significantly from the other image diagnosis. When examined by segmental border, diagnostic errors of PAE and the other image diagnosis occurred most frequently in the region under the right/middle segments. Discussion: Portal angio-echo is a useful tool for the segmental diagnosis of hepatocellular carcinoma, special caution should be exercised in making a segmental diagnosis in the region under trhe right/middle segments because examination of middle segment specimens reveals a large number of tertiary bifurications in the glissonean sheath code, involving the subsegment on the portal fissure side of the right lobe.

Key words
hepatocellulr carcinoma, preoperative segmental diagnosis, portal angio-echo, systematized hepatic resection

Reprint requests
Satoshi Katagiri Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JAPAN

Accepted
March 28, 2001

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