Surgical treatment of hepatocellular carcinoma with inferior vena cava tumor thrombus: a new classification for surgical guidance

BACKGROUND: Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique. METHODS: We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients. RESULTS: Type Ⅰ IVCTT (10 patients) was posterior to the liver and below the diaphragm; type Ⅱ IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type Ⅲ IVCTT (1 patient) was above the diaphragm and in the right atrium. Type Ⅰ was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type Ⅱ was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type Ⅲ was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1-and 2-year survival rates were 53.8% and 15.4%, respectively. CONCLUSION: Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.

Long-term survival of patients with hepatocellular carcinoma with inferior vena cava tumor thrombus treated with sorafenib combined with transarterial chemoembolization:report of two cases and literature review

The prognosis of hepatocellular carcinoma(HCC) with tumor thrombus formation in the main vasculature is extremely poor.Sorafenib combined with transarterial chemoembolization is a novel treatment approach for advanced HCC.In this study,we report two HCC patients with inferior vena cava tumor thrombus who underwent the combination treatment.The overall survival times for these two patients were 44 months and 35 months,respectively.Our report suggests that sorafenib combined with transarterial chemoembolization may be a viable choice for patients with advanced HCC even with inferior vena cava tumor thrombus.Further studies are required to verify the efficacy and safety of this combination therapy for patients with advanced HCC with inferior vena cava tumor thrombus.

Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery:A case report

BACKGROUND Acute pulmonary embolism(APE)is a rare and potentially life-threatening condition,even with early detection and prompt management.Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARY A 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava(IVC)tumor thrombus.APE that occurred during tumor thrombectomy with hypercapnia and desaturation.The capnography combined with the transesophageal echocardiography(TEE)provided a crucial differential diagnosis during the operation.The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability.He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist.There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSION Under general anesthesia for IVC tumor thrombus surgery,a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE,which occurs before hemodynamic changes.When intraoperative APE is suspected,TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram.Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.

Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus:A case report

BACKGROUND Ewing’s sarcoma of the adrenal gland with inferior vena cava(IVC)and right atrium thrombus is extremely rare.Here,we report a case of giant adrenal Ewing’s sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management.CASE SUMMARY A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months.Enhanced abdominal computed tomography revealed a large retroperitoneal mass(22 cm in diameter),which may have originated from the right adrenal gland and was closely related to the liver.Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle.After preoperative preparation with cardiopulmonary bypass,sufficient blood products,transesophageal echocardiography and multiple monitoring,tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team.Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously.During transfer of the patient to the intensive care unit(ICU),cardiac arrest occurred without external stimulus.Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min.In the ICU,extracorporeal membrane oxygenation(ECMO)and continuous renal replacement therapy(CRRT)were provided to maintain cardiac,liver and kidney function.Histopathologic examination confirmed the diagnosis of Ewing’s sarcoma.After postoperative treatments and rehabilitation,the patient was discharged from the urology ward.CONCLUSION An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare,and its anesthesia and perioperative management have not been reported.Thus,this report provides significant insights in the perioperative management of patients with adrenal Ewing’s sarcoma and IVC tumor thrombus.Intraoperative circulation fluctuations and sudden cardiovascular events are the major challenges during surgery.In addition,postoperative treatments including ECMO and CRRT provide essential support in critically ill patients.Moreover,this case report also highlights the importance of multidisciplinary cooperation during treatment of the disease.

Anti-programmed cell death ligand 1-based immunotherapy in recurrent hepatocellular carcinoma with inferior vena cava tumor thrombus and metastasis:Three case reports

BACKGROUND Recurrent hepatocellular carcinoma(HCC)with inferior vena cava tumor thrombus is a great challenge for oncologists and has a poor prognosis.To date,the safety and efficacy of programmed cell death ligand 1(PD-L1)inhibitors are still unknown.CASE SUMMARY A 59-year-old male was identified as having a tumor thrombus in the inferior vena cava 3 years after surgery.The patient underwent a second surgery and adjuvant chemotherapy.However,the level of alpha-fetoprotein was elevated after 2 mo,and lung metastases and mediastinal lymph node metastases were identified.The expression of PD-L1 in HCC and inferior vena cava tumor thrombus tissues was analyzed by immunohistochemistry.Then,the patient received atezolizumab immunotherapy.The level of alpha-fetoprotein dropped to normal,the mediastinal lymph node metastases decreased in size and the lung metastases disappeared after 3 mo of immunotherapy.The patient had no signs of recurrence at 21 mo of follow-up.A 60-year-old male underwent left hepatic tumor resection,inferior vena cava incision and thrombus removal,followed by regular chemotherapy.The patient developed lung and splenic metastases after surgery.Pembrolizumab was used for six courses,and the splenic metastasis shrank,after which splenectomy was performed.The patient continued to receive pembrolizumab for thirteen courses,and the lung metastases showed no progression.A 34-year-old male was diagnosed with liver cancer with inferior vena cava tumor thrombus.The patient underwent right hepatectomy and received tislelizumab for three courses.He is still receiving immunotherapy and in good condition.CONCLUSION Anti-PD-L1 therapy in HCC patients with inferior vena cava tumor thrombus and metastasis is associated with relatively good patient outcomes.

Insights into treatment for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium

Hepatocellular carcinoma(HCC),one of the most common liver cancers,often has a poor prognosis when it involves macrovascular invasion.Oncological emergencies including pulmonary embolism,heart failure,and even sudden death could happen when it develops a tumor thrombus(TT)in the inferior vena cava(IVC)or right atrium(RA),indicating an exceptionally grim prognosis(1).Although systemic therapy is the only standard treatment recommended by guidelines(2),other treatment modalities are explored including surgery,radiotherapy,etc.in some centers.Surgery,as the only potential curative treatment,has been explored in several selected cases.A case of long-term survival of 15 years and cancer-free survival of 9 years was reported by surgical resection with a heart-first approach under cardiopulmonary bypass(CPB)(3),suggesting that aggressive surgery together with multidisciplinary treatments might achieve long survival.However,due to the aggressiveness and challenge of surgical resection-massive resection area,potential significant blood loss,and bypass needed,surgical resection is applied in very limited centers.Nevertheless,safety,efficacy,and long-term survival benefits for these patients are poorly investigated.

Piggyback liver transplant techniques in the surgical management of urological tumors with inferior vena cava tumor thrombus

Background An important characteristic of renal cell carcinomas and adrenal tumors is that these tumors may expand into the renal vein and inferior vena cava, and transform into tumor thrombi. This study was to evaluate the use of piggyback liver transplant techniques for surgical management of urological tumors with inferior vena cava tumor thrombus. Methods Nineteen patients with renal cell carcinomas or adrenal tumors with inferior vena cava tumor thrombus were treated from November 1995 to April 2008. Their ages ranged from 29 years to 76 years （mean 54 years）. The extent of tumor thrombus was infrahepatic （level Ⅰ） in 2, retrohepatic （level Ⅱ） in 7, suprahepatic （level Ⅲ） in 6, and intra-atrial （level Ⅳ） in 4 patients. We used cardiopulmonary bypass with deep hypothermic circulatory arrest to remove the thrombi in 3 cases of level IV and in 2 cases of level Ⅲ. In all level Ⅱ, 4 level Ⅲ, and 2 level IV cases, we used piggyback liver transplant techniques to mobilize the liver off of the inferior vena cava and to separate the inferior vena cava from the posterior abdominal wall. Results Mean operative time was 5.1 hours, mean estimated blood loss was 2289 ml and mean blood transfusion was 12.84 U. One patient with adrenal cortical carcinoma and level Ⅳ thrombus died in the immediate postoperative period. Three patients were lost to follow up, and the other 15 survivors were followed from 5 months to 56 months. Eight of these 15 patients died due to metastasis; however 7 were still alive at the last follow-up. Conclusions An aggressive surgical approach is the only hope for curing patients diagnosed with urological tumors combined with inferior vena cava tumor thrombus. The use of piggyback liver transplant techniques to mobilize the liver off of the inferior vena cava provides excellent exposure of the inferior vena cava. Patients with a level Ⅱ or level Ⅲ inferior vena cava thrombus may be treated without using cardiopulmonary bypass.

Prevention of tumor emboli from the inferior vena cava by the Tempofilter II during resection of nephroblastoma with level III tumor thrombus

The optimal treatment for patients with nephroblastoma and inferior vena cava （IVC） minor thrombus is radical nephrectomy and minor thrombectomv, but the operation for patients with level III tumor thrombus is usually at high risk of puhnonary, embolism （PE）. We report one case of nephroblastoma with level III thrombus in our hospital in 2007, the vena cava tumor thrombectonly was safely performed under the protection of Tempofilter II inferior vena cava filter.

肝尾状叶切除在机器人辅助腹腔镜下腔静脉癌栓切除术中的应用:单中心经验

目的:探讨机器人辅助腹腔镜下腔静脉癌栓切除术联合肝尾状叶切除术治疗301Ⅱ~Ⅲ级下腔静脉癌栓的可行性和有效性。方法:回顾性分析2021年1月至2022年6月于解放军总医院第一医学中心行机器人辅助腹腔镜下腔静脉癌栓切除术的5例患者的临床资料,所有患者术中均联合部分肝尾状叶切除以显露肝后段下腔静脉。其中男性2例,女性3例,中位年龄61(60~75)岁;中位体质量指数24.8(21.7~25.3)kg/m2。根据301分级,Ⅱ级癌栓患者1例,Ⅲ级癌栓患者4例。下腔静脉癌栓中位高度10.8(10.4~13.1)cm,癌栓中位最大径2.0(1.5~3.9)cm。结果:5例患者手术均顺利完成,无中转开放。中位手术时间510(290~795)m i n,中位失血量1500(900~2000)ml。患者术后中位重症监护室(intensive care unit,ICU)住院时间4(0~7)d,中位总住院时间11(6~13)d。术后出现Ⅰ级并发症2例,Ⅱ级并发症3例,无围术期死亡病例。出院时该5例患者的肝、肾功能均降至基线水平。中位随访时间8.3(2.5~16.1)个月,无肿瘤复发、进展、转移等情况。结论:对于肾肿瘤伴高度毗邻第二肝门的粗大下腔静脉癌栓的患者,术中切除肝尾状叶能够更好地显露肝后段下腔静脉,有利于术中尽早控制癌栓近心端下腔静脉,从而提高手术的安全性。

双侧腹膜后途径治疗左肾癌伴0b级静脉癌栓手术运用体会

目的探讨腹腔镜下双侧腹膜后途径治疗左肾细胞癌伴0b级(301分级,癌栓超过肠系膜上动脉、未进入下腔静脉)静脉癌栓手术方式的技术要点及临床价值,并对其进行初步经验总结。方法回顾性分析2016年1月至2022年4月收治的14例左侧肾细胞癌伴0b级静脉癌栓患者的临床资料。术前行MRI、CT检查明确癌栓的位置,均为左肾静脉0b级癌栓。所有患者均经双侧腹膜后途径行腹腔镜肾癌根治术及癌栓剥除术治疗。结果所有手术均成功,无中转开放,手术时间(155.15±21.01)min,术中出血量(115.71±74.26)ml,术后住院天数中位数为5.50(IQR:5.00,6.25)d,术后引流管拔除时间中位数为3.00(IQR:3.00,4.00)d,术后平均排气时间中位数为1.50(IQR:1.00,2.00)d,术后视觉模拟评分中位数为3.00(IQR:2.75,4.00)分。结论双侧腹膜后途径的手术方式在完成治疗目的的同时,降低手术出血风险及并发症,达到快速康复的目的,是有效的处理方式。

Conversion therapy for hepatocellular carcinoma to improve treatment strategies for intermediate and advanced stages

This manuscript is based on a case reported by Song et al published in the World Journal of Clinical Cases.Several challenges remain in the field of hepatocellular carcinoma(HCC)conversion therapy.Consequently,only a limited number of patients with HCC accompanied by portal vein tumor thrombosis(PVTT)and hepatic vein tumor thrombosis(HVTT)are eligible for resection.This clinical case demonstrates that considering the complexity of the disease,a multimodal and multidisciplinary approach is essential for managing HCC accompanied by PVTT and HVTT.However,the outcomes of such surgeries remain controversial.In conclusion,research on HCC conversion therapy is extremely useful for impro-ving treatment strategies for intermediate and advanced HCC,which currently have disappointing clinical outcomes.

大鼠原位肝移植解剖重建研究进展

大鼠肝移植模型的构建,为解决临床肝移植术后并发症及围手术期治疗等问题提供了理想的动物模型。随着对大鼠肝移植模型建立的深入研究,逐渐形成了经典的“二袖套”法。然而,在移植手术过程中,手术视野差、血管扭转、胆道损伤和无肝期较长等问题仍是传统方法无法避免的。目前国内外大鼠肝移植模型改进方式主要围绕肝上下腔静脉、门静脉、肝下下腔静脉和胆管这4个重要解剖结构的重建展开。为此,本文就肝上下腔静脉、门静脉、肝下下腔静脉和胆管重建领域的最新进展进行整理总结,以便为大鼠肝移植模型的构建提供参考,促进肝移植技术的进一步发展。

调强放疗联合化疗在肝癌合并静脉/下腔静脉癌栓中的应用

目的探讨在肝癌合并静脉/下腔静脉癌栓患者治疗中使用调强放疗联合化疗的临床治疗效果。方法选取100例肝癌合并静脉/下腔静脉癌栓患者作为研究样本,以随机数字表的方式分为实验组及对照组,各50例。实验组采用调强放疗联合化疗进行治疗,对照组给予调强放疗进行治疗。比较两组患者的临床治疗效果,不良反应发生情况,治疗前后的生活质量评分及心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]评分。结果实验组有效率60.00%高于对照组的30.00%(P<0.05)。两组患者不良反应发生率比较,无统计学差异(P>0.05)。治疗后,实验组社会功能、情绪功能、角色功能、躯体功能评分分别为(90.08±4.21)、(91.27±3.16)、(91.68±5.23)、(92.89±6.19)分,均显著高于对照组的(79.61±3.42)、(78.12±6.15)、(77.26±6.12)、(78.46±5.13)分(P<0.05)。治疗后,对照组SDS及SAS评分分别为(51.72±5.51)、(53.01±4.36)分,实验组分别为(40.21±3.53)、(40.01±5.32)分,实验组均低于对照组(P<0.05)。结论肝癌合并静脉/下腔静脉癌栓患者应用调强放疗联合化疗效果明显,不仅能够改善患者的生存质量,缓解不良心理,同时不会增加不良反应,建议临床大力推广。

Extrahepatic portacaval shunt via a magnetic compression technique: A cadaveric feasibility study

AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.

Linear endoscopic ultrasound evaluation of hepatic veins

Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for successful, uncomplicated liver surgeries. Various imaging techniques like multidetector computed tomographic and magnetic resonance angiography are used to provide information about hepatic vasculature. Linear endoscopic ultrasound(EUS) can offer a detailed evaluation of hepatic veins, help in assessment of liver segments and can offer a possible route for EUS guided vascular endotherapy involving hepatic veins. A standard technique for visualization of hepatic veins by linear EUS has not been described. This review paper describes the normal EUS anatomy of hepatic veins and a standard technique for visualization of hepatic veins from four stations. With practice an imaging of all the hepatic veins is possible from four stations. The imaging from fundus of stomach is the easiest and most convenient method of imaging of hepatic veins. EUS of hepatic vein and the tributaries is an operator dependent technique and in expert hands may give a mapping comparable to computed tomographic and magnetic resonance imaging. EUS of hepatic veins can help in identification of individual sectors and segments of liver. EUS guided interventions involving hepatic veins may require approach from different stations.

机器人辅助与开放手术 治疗肾癌并Mayo Ⅰ~Ⅲ 级下腔静脉癌栓的效果比较

目的比较机器人辅助与开放手术治疗肾癌并下腔静脉癌栓的临床疗效,分析机器人辅助根治性肾切除并腔静脉癌栓切除术治疗肾癌并下腔静脉癌栓的安全性和可行性。方法回顾性分析2015年12月-2021年12月由郑州大学第一附属医院同一术者收治的55例肾癌并MayoⅠ~Ⅲ级下腔静脉癌栓患者的临床资料。根据手术方式分为机器人辅助组(36例)和开放手术组(19例),比较两组的围术期资料、肿瘤学结果及生存情况。结果55例患者手术均顺利完成,手术中位时间176(IQR:137~234)min,9(16.4%)例患者围手术期并发症≥Ⅲ级。机器人手术组较开放手术组的术中出血量[300(200~625)mL vs.1000(600~1184)mL]、输血比例[(20/36)vs.(18/19)]低,而术后血红蛋白水平[109(98~120)g/L vs.90(84~100)g/L]较高。中位随访时间为26(IQR:19~39)个月,19(34.5%)例患者发生新发转移,12(21.8%)例患者死亡。两组(机器人辅助组vs.开放手术组)术后的肿瘤特异性生存时间(HR=0.39,95%CI:0.13~1.16,P=0.090)及总生存时间(HR=0.71,95%CI:0.22~2.23,P=0.554)比较差异无统计学意义。结论机器人辅助与开放手术治疗MayoⅠ~Ⅲ级下腔静脉癌栓的术后并发症、肿瘤无进展生存时间和总生存时间差异无统计学意义,但机器人辅助根治性肾切除并腔静脉癌栓切除术术中出血量低于开放手术。

经胸超声心动图发现下腔静脉及右心房占位一例

本文报道1例以腹水及双下肢水肿为首发表现,经超声心动图发现下腔静脉及右心房占位,结合甲胎蛋白明显升高、影像学检查临床诊断肝癌合并下腔静脉及右心房癌栓,应用靶向治疗联合免疫治疗后肿瘤有所缩小,甲胎蛋白明显降低,提示靶向治疗联合免疫治疗有效。本例患者中位生存时间3个月,有明确的乙肝肝硬化病史,临床诊断肝癌已经晚期,提示进行早期肝癌筛查的重要性。

机器人辅助腹腔镜单一体位右侧肾癌根治并下腔静脉Ⅲ级癌栓取栓术

目的探讨单一体位机器人辅助腹腔镜根治性肾切除并下腔静脉Ⅲ级癌栓切除术的关键步骤及围术期结果。方法患者女性,57岁。10 d前至当地医院体检,B超检查示右肾占位。MRI进一步检查示右肾实性占位,考虑透明细胞癌,伴右肾静脉及肝段下腔静脉内癌栓形成。超声造影示下腔静脉肝后段可见一低回声占位,范围约74 mm×40 mm,边界尚清,上缘距膈肌约19 mm。关键手术步骤:(1)切开侧腹膜向内推开结肠和十二指肠,游离、显露下腔静脉和左肾静脉。(2)在下腔静脉与腹主动脉之间左肾静脉后上方找到右肾动脉,用Hem-o-lok夹闭后切断。(3)在右侧肾静脉下方游离下腔静脉,结扎性腺血管及部分腰静脉,下腔静脉远心端游离后放置血管阻断带备阻断用。(4)将左肾静脉、第一肝门适当游离后,分别放置血管阻断带备阻断用。(5)沿下腔静脉向上分离,切断肝脏三角韧带、右侧冠状韧带后挑起肝脏,游离出右侧肾上腺中央静脉后用Hem-o-lok夹闭后切断。(6)解剖出肝后间隙并建立部分肝后隧道,游离右肝,分离并结扎下腔静脉外侧缘的肝短静脉;挑起肝尾状叶再解剖肝后间隙并结扎部分下腔静脉内侧缘的肝短静脉。(7)将右肝向左侧旋转显露肝后段下腔静脉后,沿下腔静脉外侧缘在膈下切断部分膈肌后,游离膈下下腔静脉,将下腔静脉游离后放置血管阻断带备阻断用。(8)依次阻断下腔静脉远端、左肾静脉、第一肝门和下腔静脉近心端。(9)切开下腔静脉后取出癌栓,将右肾及癌栓整块装入标本袋。(10)用4-0血管缝线缝合下腔静脉,再依次松开血管阻断带后检查血管有无渗血。结果手术顺利完成,手术时间340 min,术中出血量400 ml,术中输注红细胞2 U和400 ml冰冻血浆。围术期患者肌酐正常,未出现明显并发症,术后10 d出院。随访26个月,患者一般情况良好,未出现复发或转移。结论机器人辅助腹腔镜Ⅲ级癌栓取出术中,患者采取单一体位、由单一主刀医生完成手术,手术具有操作简单、术中无需更改体位、节省手术时间、创伤小、恢复快、并发症发生率低的优点,是一种安全、可行的治疗肝后下腔静脉癌栓的方法,需要选择合适的病例、完善围术期评估,并由经验丰富的机器人手术医生操作完成。

改良机器人辅助腹腔镜下右肾癌根治术联合下腔静脉Ⅰ级癌栓切除术一例报道(英文)

下腔静脉癌栓切除术是泌尿系统最复杂和最具挑战性的手术之一。本文报道1例改良的机器人辅助腹腔镜下右肾癌根治术联合下腔静脉I级癌栓切除术。相比常规下腔静脉癌栓切除术,改良的机器人辅助腹腔镜下腔静脉癌栓切除术不需要完全分离下腔静脉,无需结扎腰静脉、肾上腺静脉,不用阻断下腔静脉、左肾静脉,也不需要切开下腔静脉和重建下腔静脉。本例手术先完全分离右肾,然后向侧面抬起右肾,使下腔静脉内的瘤栓降至肾静脉入下腔静脉处,然后用机械臂将瘤栓完全推进右肾静脉内,在不阻断下腔静脉的情况下完整切除瘤栓。此改良手术成功完成,无任何并发症,未进行输血。患者随访4年后无任何复发迹象。这表明此改良手术简单、安全、可行、值得推广,尤其适用于初学者。

大鼠肝移植无肝期研究进展

随着肝移植手术器械、方法和技术不断发展,其疗效日益提升,但无肝期时间的长短仍是影响肝移植效果的重要因素。大鼠是肝移植相关基础研究的主要动物模型之一,本文就延长大鼠肝移植无肝期持续时间及缩短大鼠肝移植无肝期操作时间的方法,包括吸入性七氟烷麻醉、颈静脉留置针补液、无肝期前夹闭腹主动脉、无肝期前门静脉注入生理盐水、脾脏皮下转位术、肝食管动脉电凝离断、肝上下腔静脉磁环吻合、肝上下腔静脉套管吻合、肝上下腔静脉支架吻合、门静脉快速连接装置套管、肝下下腔静脉保留肝脏组织环套管进行综述,为延长大鼠无肝期持续时间,提高无肝期操作效率,提升大鼠肝移植成功率提供参考。