合并下腔静脉癌栓原发性肝癌的手术治疗及其价值

Study of the hepatic resection for hepatocellular carcinoma with tumor thrombus extending into inferior vena cava and its vlue

目的探讨合并下腔静脉癌栓原发性肝癌的手术治疗方法及其价值。方法自2000年11月～2004年12月我科采用全肝血流阻断技术,实施10例肝癌及下腔静脉、肝静脉内癌栓切除手术。其中肝血流阻断手术方法包括有:1.Pringle蒺s手法+肝上下腔静脉侧壁肝静脉阻断(2例);2.Pringle蒺s手法+肝上肝下下腔静脉联合阻断(7例);3.Pringle蒺s手法+经膈下胸纵隔内下腔静脉阻断+肝下IVC阻断(1例)。并对其疗效进行观察。结果10例手术均获成功。9例患者术后半年内复发,1例至今术后3月未见复发。全组病人中位生存期6个月。结论采用全肝血流阻断技术下,实施肝癌及下腔静脉、肝静脉内癌栓切除手术,技术安全可行,然而如何加强防止手术后复发是将来研究重点。

Objective To investigate new surgical modality for hepatocellular carcinoma （HCC） with inferior vena cava （IVC） tumor thrombi extension and its value. Methods From November 2000 to December 2004, 10 cases of HCC with IVC tumor thrombi extension received operation were analyzed retrospectively. Three different kinds of total hepactic vascular exclusion （THVE） were applied during operation. They were Pringle＇s maneuver and suprabepatic IVC plus hepatic vein exclusion （for 2 cases）, Pringle＇s maneuver combined suprahepatic IVC with infra hepatic IVC exclusion （for 7 cases）, Pringle＇s maneuver plus infrapericardial IVC and infrabepatic IVC exclusion（for 1 case）. Hepatectomy and tumor thrombectomy were accomplished simultaneously during one time of vascular exclusion. Result All surgical procedures were successfully performed without major intraoperative and postoperative complications. Among them, 9 cases underwent relative curative surgery,and 1 had only palliative resection （tumor debulking） because of the huge tumor involved in both lobe which presented chest cavity compression. The recurrence was happened in 9 cases within half a year. One case had no recurrence with normal life until now and who had operation 3 months ago. The median survival was 6 months in this group. Conclusion Procedure of simultaneous hepatectomy and tumor thrombectomy under THVE is a applicable method for elective HCC patients. How to prevent postoperative recurrence of HCC is still the key point for the surgeons to research.