Health News reported on February 10: “Huge hepatic caudate lobe tumor!” Half a month ago, when his father’s CT report appeared in front of his eyes, Xiao Sun (pseudonym), a northeastern man, was confused at once. According to the local doctor’s description, his father’s tumor grew on the caudate lobe of the liver, which is a rare tumor in this location, and the caudate lobe of the liver grows in a special location, in front of the portal vein, hepatic artery and the left and right hepatic ducts that supply blood to the liver, and behind it is close to the inferior vena cava, the largest vein in the human body, and above it is close to several hepatic veins that drain blood from the liver and converge into the inferior vena cava. Therefore, it is extremely difficult and risky to remove the tumor from the caudate lobe of liver. Xiao Sun’s father’s tumor was very large, with a diameter of more than 5cm, and it was likely to have invaded the inferior vena cava, so if he was not careful during the surgery, it might damage the large blood vessels and cause fatal hemorrhage. The doctor suggested, “We can’t cure this disease here, so go to Beijing.” Peng Jirun of the Department of Hepatobiliary Surgery, Beijing Saitan Hospital, Capital Medical University Xiao Sun took his father to Beijing, and after a few changes, he found Professor Peng Jirun of the Department of General Surgery, Beijing Saitan Hospital, Capital Medical University, through an acquaintance. Professor Peng Jirun is a well-known expert in hepatobiliary surgery in China. He has been engaged in liver surgery and research for more than 20 years and has extremely rich experience in liver resection. Professor Peng inquired about the detailed medical history and carefully reviewed the patient’s imaging and other auxiliary examination data. Considering that the patient’s diagnosis was clear, and that although the caudate lobe tumor was large and closely related to the inferior vena cava, there was still a possibility of resection after efforts, the patient was admitted to the hospital. After the patient was admitted to the hospital, during the preoperative examination and preparation, another unexpected situation was encountered: the blood type test showed that the patient was Rh-negative. This is a very rare blood type, which accounts for only 0.34% of the total population in China, and is known as “panda blood type” by the general public. will induce a serious acute hemolytic transfusion reaction. Because of the low percentage of Rh-negative blood in the population and the low stock of this blood in blood banks, it is difficult to get enough surgical blood for patients with this blood type. One of the biggest risks of liver surgery is intraoperative bleeding, especially when Prof. Peng Jirun’s team was dealing with a patient with a very difficult hepatic caudal lobe tumor, and if there was not enough blood available for intraoperative bleeding, the patient would be in a very dangerous situation. What was even more frustrating was that it was the end of the year and the beginning of the year, the most difficult time for blood shortage for surgery in Beijing, and it was a headache for the blood bank directors of major hospitals in Beijing to match blood for patients with regular blood types, not to mention this rare blood type. In this situation, how to prepare sufficient blood for this patient with special disease and special blood type became a big problem in front of Prof. Peng Jirun’s team. Under the coordination of Prof. Peng, the general surgery department, blood transfusion department and anesthesiology department actively cooperated and adopted a “three-pronged” strategy to find blood: one week before the operation, the blood transfusion department first drew 400ml of the patient’s autologous blood and froze it; at the same time, Director Chunrong Tan and colleagues actively contacted the Beijing Blood Center and prepared 1000ml of allogeneic blood after several attempts. At the same time, Director Tan Chunrong and his colleagues actively contacted Beijing Blood Center and prepared 1000ml of allogeneic blood after several efforts; Director Zhao Binjiang of the Department of Anesthesiology decided to take another 400ml of autologous blood on the day of the operation and before the operation started according to the patient’s specific condition. 1800ml, which was the total amount of blood prepared, seemed to be quite a lot, but it was still very stressful for a case of liver caudate lobe tumor resection with great risk of bleeding. After repeatedly reading the relevant imaging data and full argumentation together with the radiologist, Prof. Peng and his surgical team made a well thought out bloodless liver resection surgery plan. After careful preparation, the patient was wheeled into the operating room. The director of the anesthesiology department, Zhao, personally anesthetized the patient, the head nurse patrolled the table, and all the supporting staff were standing by. Everything went smoothly according to the preoperative plan: opening, freeing, probing, and the huge tumor was presented before the operator’s eyes. Consistent with the preoperative assessment, it was located between the portal vein and inferior vena cava, with a diameter of more than 5cm, a deep location, and very rich blood flow, making the operation obviously very difficult. With the cooperation of his assistant, Professor Peng separated all the attached ligaments, fully freed the liver, exposed the posterior inferior vena cava throughout, and prepared for emergency treatment. The most difficult part of the surgery was to completely separate the tumor from the inferior vena cava, which is the most delicate operation in liver surgery. There are more than 10 short hepatic veins with thin walls and different sizes connecting the posterior liver, the caudal lobe tumor and the inferior vena cava together. Professor Peng separated, clamped, cut and sutured them one by one with fine movements …… until the tumor was completely separated from the inferior vena cava. The moment of removing the tumor came. When cutting off the connection between the tumor and the normal liver, in order to protect the patient’s liver function to the greatest extent, Prof. Peng decided not to block the blood flow into the liver from the portal part of the liver, but to use the advanced electrosurgery workstation technology to separate the liver and combine with the fine ligation of blood vessels and bile ducts to stop the bleeding while removing, so as to minimize the patient’s bleeding until the tumor was completely removed, and the total bleeding was only 200. At this time, the total surgical bleeding was only 200 ml. After the operation, the patient was discharged from the hospital soon after careful care by the medical staff of the Department of General Surgery. When summarizing the experience of this special patient, some experts said that bloodless resection of liver caudate lobe tumor is a major technical problem in the field of liver surgery, and the success of this case shows that Beijing Severance Hospital has reached a new level in the surgical treatment of liver surgical diseases. (Propaganda Center, Department of General Surgery I)