术中超声诊断右肝癌伴右肝静脉、下腔静脉栓子1例

Intraoperative ultrasonographic diagnosis of hepatocellular carcinoma with inferior vena cava thrombus:A case report

肝细胞癌(hepatocellular carcinoma,HCC)容易出现肝内血管的癌栓,癌栓累及下腔静脉的较少.一旦出现则情况危急,需要明确诊断,妥善处理.本例患者术前经腹部超声甚至是增强CT均漏诊下腔静脉栓子.术中超声(intraoperative ultrasonography,IOUS)发现并准确定位栓子.该患者进行了两次取栓术,也进行了两次IOUS检查,第一次取栓后进行了IOUS检查,发现仍然残留有栓子.又进行了第二次取栓,IOUS复查见栓子已取干净.IOUS目前在临床中并未广泛开展.IOUS对肝癌中可能出现的小癌栓、一些小的转移灶和血管的栓塞均有很高的敏感性,而这些征象经腹部超声或其他影像学检查可能无法发现.IOUS对下腔静脉癌栓的清除评价具有一定的临床指导价值.IOUS作为一种方便、有效的检查手段,若有条件,在肝脏肿瘤手术中应该更广泛地应用.

Patients with hepatocellular carcinoma （HCC） are very much prone to thrombosis of intra hepatic vessels. However, tumor thrombus involving the inferior vena cava （IVC） is rare. In complicated cases, proper diagnosis and management is mandatory. In this case, tumor embolus inside the IVC was missed on pre operative abdominal ultrasound and even on preoperative CT examination. However, the embolus was discovered accurately and the location was assessed correctly during intra operative ultrasound （IOUS） examination. The patient underwent two embolectomies and two IOUS examinations. After the first embolectomy, IOUS revealed residual embolus inside the IVC. A second embolectomy was then performed to completely remove the embolus. Although IOUS has greater sensitivity in detecting potential small tumor thrombi in HCC, small metastasesand vascular embolization which may not be detected by routine abdominal ultrasonography or other imaging modalities, IOUS is not widely carried out in clinical examination and surgical management. Therefore, IOUS has greater clini cal importance in cases of IVC embolization and surgical management and is a very convenient and effective means of imaging procedure.