半离体或离体肝切除联合自体肝移植适应证探讨(附36例报告)

Research on the indications of half in situ or ex situ liver resection and liver autotransplantation:A report 36 cases

目的探讨半离体或离体肝切除联合自体肝移植的适应证及相关问题。方法回顾性分析2005年10月至2011年12月武汉大学中南医院和中南大学湘雅三医院收治的36例行半离体或离体肝切除联合自体肝移植病人的临床资料,按疾病及解剖适应证进行分类整理。结果术中2例病人在开放IVC血流后并发心跳骤停,经处理后恢复心跳,其余34例病人手术过程顺利。截至2013年5月,术后34例病人获得随访,随访时间为4.0（2~8）年。13例良性疾病病人术后复发1例（肝包虫病）,行射频消融（RFA）治疗,仍带病存活。23例恶性病变病人中失访2例,术后复发10例,存活13例,最长存活时间为7.5年。结论当肿块位于以下5种解剖结构时可考虑行半离体或离体肝切除联合自体肝移植：（1）肝右静脉、肝中静脉与肝后下腔静脉构成的三角区;（2）肝左静脉、肝中静脉与肝后下腔静脉构成的三角区;（3）肝尾状叶及肝段Ⅳ;（4）门静脉左支、肝中静脉主干与肝后下腔静脉构成的三角区;（5）门静脉右支、肝中静脉主干与肝后下腔静脉构成的三角区。

Objective To research indications and association issues of half in situ or ex situ liver resection and liver autotransplantation. Methods The clinical data of 36 cases of half in situ or ex situ liver resection and liver autotransplantation completed form October 2005 to December 2011 in Zhongnan Hospital of Wuhan University and the Third Xiangya Hospital of Central South University were analyzed retrospectively and sorted in disease species and anatomical indications. Results Cardiac arrest occurred in 2 cases and operation was successful in other 34 cases. A total of 34 cases were followed up with a median follow-up of 4 years（ 2-8 years） as of May 2013. Only one of the 13 cases with benign disease had primary recurrence 5 months later with the hydatid violated the residual bile duct surrounding tissue,and was survival under the RFA treatment. Ten of 23 cases of maligant disease had postoperative tumor metastasis recurrence and the remaining 13 cases were still alive, the longest one survived 7.5 years. Conclusion The following 5 anatomic structures of tumor position can be implemented with half in situ or ex situ liver resection and liver autotransplantation：the trigonum of right hepatic vein（RHV）,middle hepatic vein（MHV） and retrohepatic inferior vena cava（RIVC）;the trigonum of left hepatic vein（LHV）,MHV and RIVC;caudate lobe and segmentⅣ;the trigonum of left branch of portal vein（LPV）,trunk of MHV and RIVC;the trigonum of right branch of portalvein（RPV）,trunk of MHV and RIVC.