肝癌肝移植术中的无瘤操作技巧

The technique of non-touch during liver transplantation for hepatocellular carcinoma

目的 探讨肝癌肝移植术中的无瘤操作技巧。方法 7例肝癌患者实施肝移植。尽早建立静脉转流通道及断离门静脉、下腔静脉。游离肝脏时尽量不触及、压迫肿瘤;B超测量癌肿与下腔静脉、肝静脉、门静脉关系,确定血管是否切除及切除范围。结果 手术后2月,所有患者AFP均降至正常水平,肝脏未发现复发病灶,PET检查未见远处转移。结论 尽早建立静脉转流通道。手术中坚持癌肿切除的一般原则,同时针对肝移植特点,利用B超确定血管是否切除及切除范围,是预防肝癌肝移植术后复发的有效的手段。

Objectives To investigate the technique of non-touch during liver transplantation for hepatocellular carcinoma. Methods 7 cases with liver cancer underwent liver transplantation. The venous bypass were built and portal vein and inferior vena cava were cut off as early as possible. When the liver was seperated, the tumor didn't touch and crush as far as possible. Using Doppler ultrasound to determine the relationship between the cancer and inferior vena cava, hepatic vein and portal vein, and then the resecting extent of blood vessels were comfirmed. Results AFP was declined to normal range after operation 2 months in all cases. No recurrent lesions and no distant metastasis were found by MRI, Doppler ultrasound and PET examination. All cases were still survival after operation 2 months. The longest survival of 1 case had reached to 33 months. Conclusion The venous bypass is establish as early as possible. Effective measure to prevent postoperative recurrence of liver transplantation which are insisting on the general principle of non-touch and it decides resecting extent of blood vessels with Doppler ultrasound during operation.