CAJ | 학술논문

目的评估体外肝切除自体肝移植在巨大肝癌患者复杂肝切除中的临床价值.方法回顾性分析2008年1月至2010年5月首都医科大学附属北京朝阳医院收治的4例巨大原发性肝癌患者的临床资料.肿瘤最大直径10 ～ 18 cm,病灶不同程度地累及了第一、二、三肝门.患者难以耐受常规肝切除,均行体外肝切除自体肝移植.结果 4例患者顺利完成手术,手术时间690 ～840 min,无肝期250～300 min,术中出血量400～1400 ml,术中无肝期未行门、腔静脉转流术.4例患者在体外肝切除后行下腔静脉或肝静脉及门静脉修复成型,均应用成型异体血管来延长剩余肝脏肝上腔静脉以利于腔静脉吻合及第一肝门的重建.本组患者1例术后肝功能正常,1例出现腹腔出血再次手术止血,1例发生肝功能不全,1例出现肝肾功能不全于术后5d放弃治疗而死亡.3例术后生存的患者术后1～2个月间剩余肝脏均发生不同程度的代偿增生.术后生存的3例患者中2例分别于术后8、9个月发现肺部多发转移瘤,分别于术后13个月及15个月死亡.随访截至2012年4月,1例患者无瘤生存37个月.结论体外肝切除自体肝移植为复杂肝切除的巨大肝癌患者提供了技术上的可行性,术后肝功能代偿不全及近期肿瘤的复发是限制该手术发展的主要问题.
목적 평고체외간절제자체간이식재거대간암환자복잡간절제중적림상개치.방법 회고성분석2008년1월지2010년5월수도의과대학부속북경조양의원수치적4례거대원발성간암환자적림상자료.종류최대직경10 ～ 18 cm,병조불동정도지루급료제일、이、삼간문.환자난이내수상규간절제,균행체외간절제자체간이식.결과 4례환자순리완성수술,수술시간690 ～840 min,무간기250～300 min,술중출혈량400～1400 ml,술중무간기미행문、강정맥전류술.4례환자재체외간절제후행하강정맥혹간정맥급문정맥수복성형,균응용성형이체혈관래연장잉여간장간상강정맥이리우강정맥문합급제일간문적중건.본조환자1례술후간공능정상,1례출현복강출혈재차수술지혈,1례발생간공능불전,1례출현간신공능불전우술후5d방기치료이사망.3례술후생존적환자술후1～2개월간잉여간장균발생불동정도적대상증생.술후생존적3례환자중2례분별우술후8、9개월발현폐부다발전이류,분별우술후13개월급15개월사망.수방절지2012년4월,1례환자무류생존37개월.결론 체외간절제자체간이식위복잡간절제적거대간암환자제공료기술상적가행성,술후간공능대상불전급근기종류적복발시한제해수술발전적주요문제.
Objective To evaluate the feasibility and efficacy of ex-vivo liver resection combined liver autotransplantation for patients with massive primary liver cancer who underwent complex liver resection.Methods The clinical data of 4 patients suffering from massive primary liver cancer who were admitted to the Beijing Chaoyang Hospital from January 2008 to May 2010 were retrospectively analyzed.Regular liver resection could not be carried out because the first,second and third hepatic hilum of the 4 patients were invaded by the tumors,so ex-vivo liver resection combined liver autotransplantation were performed.Results The operation was successfully carried out for the 4 patients.The operation time,the duration of anhepatic phase and the volume of operative blood loss were 690-840 minutes,250-300 minutes and 400-1400 ml,respectively.Portacaval bypass operation was not performed.After ex-vivo liver resection,the inferior vena eava or hepatic vein and portal vein of the 4patients were repaired,and the allogenous blood vessels were kept to extend the superior vena cava of the remnant liver so as to facilitate the anastomosis of blood vessels and reconstruction of the first hepatic hilum. After operation,the hepatic function of 1 patient was back to normal; 1 patient who stfffered from abdominal hemorrhage received reoperation for hemostasia; 1 patient was found with hepatic dysfunction; 1 patient died of hepatorenal dysfunction at postoperative day 5.Compensatory hypertrophy was observed in the 3 patients who survived at postoperative months 1-2.Of the 3 patients,2 were found with multiple pulmonary metastases at postoperative months 8 and 9,and they died at postoperative mouths 13 and 15.Until April 2012,1 patient survived for 37 months with no tumor recurrence or metastasis. Conclusions Ex-vivo liver resection combined liver autotransplantation provides the technical feasibility for performing complex liver resection for patients. The incomplete compensation of liver function and the short-term recurrence of tumors after operation are still the main issues which hinder the development of this technique.