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张 涛, 黄纪伟, 曾 勇.肝细胞癌合并下腔静脉癌栓的外科治疗.四川大学学报(医学版),2013,44(6):1005-1008
肝细胞癌合并下腔静脉癌栓的外科治疗
Surgery for Patients with Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombus
  
中文关键词:  肝细胞癌 下腔静脉 癌栓 前入路 全肝血流阻断
英文关键词:Hepatocellular carcinoma Inferior vena cava Tumor thrombus Anterior approach
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中文摘要:
      目的 探讨肝细胞癌(HCC)合并下腔静脉(IVC)癌栓外科治疗的方法、可行性及安全性。 方法 分析总结10例HCC合并IVC癌栓患者应用前入路不阻断肝门断肝,然后在全肝血流阻断(THVE)下切除癌肿组织(超出癌肿组织1 cm),并取净IVC癌栓的治疗效果。结果 10例HCC合并IVC癌栓患者均成功切除肿块和取净癌栓。平均手术时间202(145~300) min,平均全肝阻断时间22(15~26) min,平均手术失血量1 463(650~3 500) mL。1例患者围手术期死亡;4例患者术后出现一过性肝功能不全,经积极治疗均恢复;其余5例患者术后恢复良好。除围手术期死亡1例外,其余9例术后分别生存3~19月。结论 HCC合并IVC癌栓并非手术禁忌症,肝切除联合下腔静脉切开取癌栓可行。
英文摘要:
      Objective To investigate the surgical procedure, safety and efficacy of liver resection with inferior vena cava (IVC) thrombectom y in the treatment of the patients with hepatocellular carcinoma (HCC) and IVC t umor thrombus. Methods A retrospective study was conducted to an alyze the data of 10 patients with HCC and IVC tumor thrombus undergoing liver r esection and thrombectomy was analyzed. The surgical procedure included two part s, firstly the involving liver lobes were transected using the anterior approach without pedicle clamping, then the tumor thrombus were removed from the IVC und er total hepatic vascular exclusion (THVE). Results All lesion s and tumor thrombus were successfully removed. The mean operation and THVE time were 202 and 22 minutes respectively. The mean intraoperative blood loss was 1 4 63 mL and the mean postoperative hospital stay was 12 days. One patient died of h epatic and renal function failure within 30 days after surgery. Hepatic insuffic iency was seen in four cases and was successfully treated. The rest experienced uneventful postoperative recovery course. One patient died in the perioperative period and the rest had the postoperative life span ranging from 3 months to 19 months. Conclusion Hepatocellular carcinoma with IVC tumor thr ombus is not a contraindication for surgery. Liver resection combined with IVC t hrombectomy can be safely performed.
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