肝癌合并下腔静脉癌栓11例的外科治疗体会

Surgical treatment of hepatocellular carcinoma with inferior vena cava tumor thrombosis: report of 11 cases

目的探讨并总结肝细胞癌 (肝癌 )合并下腔静脉 (inferiorvenacava,IVC)癌栓手术治疗的方法和经验。方法对 11例肝癌合并IVC癌栓患者进行了手术治疗 ,手术先在入肝血流阻断下作肝癌原发灶切除 ,然后再阻断IVC血流行切开取栓。结果本组 11例原发灶和IVC癌栓均成功切除 ,全组无手术死亡 ,术中、术后均未发生与IVC取栓相关的并发症。平均手术时间为 179(12 0～ 2 5 5 )min ,平均手术失血量为 14 82 (6 0 0～ 30 0 0 )ml,平均肝门阻断和全肝血流阻断时间分别为2 7 9(12～ 83)min和 16 5 (7～ 2 8)min。术后发生胸水 1例、胆漏 1例 ,均治愈 ;随访 3例已死亡 ,8例存活 1～ 14个月。结论肝癌合并IVC癌栓的手术可安全施行 ,手术应先作原发灶切除再作IVC切开取栓。

ObjectiveThis study was to review our experience for the management of hepatocellular carcinoma(HCC) invading the inferior vena cava(IVC). Methods Eleven patients were operated on. Tumors were first resected under portal triad clamping(PTC) and then the tumor emboli in the IVC were removed either under hepatic vascular exclusion(HVE) or under side clamping of the IVC. Results Surgery was successful in all cases, without operative death and complication caused by the removals of tumor emboli from the IVC. The mean operative time was 179 min (range 120～255 min) and the mean intraoperative blood loss 1 482 ml(range 600～3 000 ml). The mean PTC and HVE times were 27 9 min(range 12～83 min) and 16 5 min(range 7～28 min), respectively. The postoperative complications included pleural effusion in one needing thorancentesis and bile leak in one. During the follow up, 3 patients died at 30, 10 and 14 months, respectively, and the remaining 8 patients were alive at the follow up of 1 to 14 months. ConclusionsHCC with tumor thrombus in the IVC is operable and the proper procedure is hepatectomy plus thrombectomy with a favourable postoperative prognosis.