肝癌伴下腔静脉癌栓的分型及外科治疗

Clinical classification and surgical treatment for hepatocellular carcinoma with inferior vena cava tumor thrombus

目的探讨肝细胞癌伴下腔静脉癌栓（hepatocellular carcinoma with inferior vena cava tumor thrombus, HCIVCTT）的分型方法，并根据分型选择合理的外科治疗方式。方法回顾性分析我院8例接受手术治疗的HCIVCTT患者。其中男7例，女1例，平均年龄44岁。结合术前影像和术中食道超声判定癌栓位置，将HCIVCTF分为3型：Ⅱ型（膈下型）2例：癌栓位于膈肌水平之下，肾静脉之上。行肝切除、膈下全肝血流阻断、下腔静脉（IVC）切开取栓；Ⅱ型（膈上型）5例：癌栓位于膈肌与右心房入口之间。行肝切除、膈上全肝血流阻断、经腹切开膈肌显露膈上IVC并阻断、切开IVC取栓；Ⅲ型（心内型）1例：癌栓已进入右心房。经胸腹联合切口，肝切除、静脉转流、右心房及IVC切开取栓。结果全组病例手术均获得成功，无1例术中死亡。术中全肝血流阻断时间为6～10min，术后中位生存时间8．4个月。结论结合术前影像和术中食道超声检查，根据癌栓位置所提出的分型方式，对于外科治疗HCIVCTT具有一定的指导价值。

Objective To explore the-clinical classification and surgical treatment for hepatoeellular carcinoma with inferior vena cava tumor thrombus （HCIVCTT）. Methods 8 patients with HCIVCTT who underwent surgical treatment in our hospital were retrospectively analyzed. There were 7 male and 1 female patients, the average age was 44 years. HCIVCTT was classified into three types： Type I （ subphrenic type, 2 patients） ： the top pole of IVCTT is located between the diaphragm and the renal vein. Type I patients were treated by hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type 11 （ intrathoracic type, 5 patients） ： the top pole of IVCTT is located between the diaphragm and the entrance of right atrium. Type II was treated by hepatectomy and removal of IVCTT under total hepatic vascular exclusion through an incision of the diaphragm to abdominal cavity. In type m （ intracardiae type, 1 patient） the tumor thrombus extending into the right atrium, hepatectomy and resection of the thrombus from the fight atrium under cardiopulmonary bypass was undertaten. Results There were no major surgical complications and no mortality. Time of total hepatic vascular exclusion was 6 - 10 min, the median survival time was 8.4 months. Conclusions Combined with preoperative imaging and intraoperative transesophageal echocardiography the upper pole of IVCTT was identified which helps to determine the surgical approach for HCIVCTT.