非转流冷灌注下离体肝切除术的临床观察

Clinical observation of ex - situ liver surgery under hypothermic perfusion and no veno - venous bypass

目的探讨非转流冷灌注下的离体肝切除术，治疗位于肝门和肝静脉下腔静脉汇合处的巨大肝脏肿瘤的可行性及安全性。方法回顾分析常规手术方法难以完整切除的1例巨大血管瘤和2例胆管细胞癌患者临床资料，评估非转流冷灌注下的离体肝切除术的治疗方法及效果。结果3例患者的手术时间分别为6．6h、6．4h、7．3h，无肝期时间分别为3．8h、2．8h、4．0h。例1术后肿瘤无复发生存时间60个月例2术后复发生存25个月；例3因术后流出道狭窄，急诊行流出道扩大术，亲体辅助性肝移植术，最后于二次术后死于肝、肾功能衰竭。结论冷灌注非体外静脉转流下离体肝切除技术拓展了外科治疗复杂肝脏肿瘤的思路，为常规手术无法切除的肿瘤治疗提供了新的选择，缩短了手术时间和无肝期、减少了对肝移植的需求，将来能否普及仍有待于临床进一步的论证。

Objective To investigate the safety and feasibility of ex - situ liver surgery under hypothermic perfusion and no veno - venous bypass for huge tumor involving hepatic hilum and/or IVC. Methods The clinical data of 2 patients with chloangiocarcinoma and 1 with haemangioma treated by ex - situ liver surgery under no veno - venous bypass were retrospectively analyzed, and the method and efficacy were evaluated. Results Operative duration and anhepatic phase of three cases were 6.6,6.4,7.3 h and 3.8,2.8,4.0 h,respectively. The first case had a disease - free survival of 60 months;The second case had postoperative recurrence and a survival of 25 months; As for the third case ,which was complicated by hepatic vein outflow obstruction after operation, it underwent emergency hepatic vein outflow extending operation and assistant living donor liver transplantation in the next day ,finally dying of liver and renal failure after second operation. Conclusion Though ex - situ liver surgery under hypothermic perfusion and no veno - venous bypass possesses the virtue of shortened operative duration and anhepatic period as well as reduced transplantation fee, postoperative mortality rate is still high. The assessment of the final therapeutic value of the method requires further experience.