Mukaiya M, Hirata K, Yamashiro K, Katsuramaki T, Denno R
First Department of Surgery, Sapporo Medical University, School of Medicine, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2532-4.
Hepatocellular carcinoma in Japan is frequently complicated by chronic hepatic disease such as chronic hepatitis and liver cirrhosis, and it is often impossible to decide the range to be resected only based on clinical stage and other tumor factors. We experienced a case with advanced hepatocellular carcinoma complicated by liver cirrhosis that directly infiltrated into the right and middle hepatic vein. Right trisegmentectomy was performed, the tumor site was extracorporeally removed and the hepatic posterior segment was autotransplanted. An anastomosis of the right hepatic vein and the inferior vena cava was performed with a vascular prosthesis. The patencies of the anastomosed vessels in the vascular reconstructions were confirmed by Doppler sonography, which was very useful, providing an easy and exact evaluation of hepatic blood flow at the patient's bedside. Throughout the post-operative course before the patient's discharge, no abnormal hepatic function was found. Though cases for which partial hepatic autotransplantation is appropriate may be few, this operation procedure, which applies hepatic transplantation techniques, is significant in that it increases the resectability and achieves curative resection of hepatocellular carcinoma.
在日本，肝细胞癌常并发慢性肝病，如慢性肝炎和肝硬化，仅根据临床分期和其他肿瘤因素往往无法确定切除范围。我们遇到一例晚期肝细胞癌合并肝硬化的病例，肿瘤直接浸润至肝右中静脉。实施了右三叶切除术，将肿瘤部位在体外切除，并对肝后段进行自体移植。使用血管假体进行了肝右静脉与下腔静脉的吻合。通过多普勒超声确认了血管重建中吻合血管的通畅情况，这非常有用，可在患者床边轻松、准确地评估肝血流。在患者出院前的整个术后过程中，未发现肝功能异常。尽管适合部分肝自体移植的病例可能很少，但这种应用肝移植技术的手术方法具有重要意义，因为它提高了肝细胞癌的可切除性并实现了根治性切除。
