Raab R, Schlitt H J, Oldhafer K J, Bornscheuer A, Lang H, Pichlmayr R
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany.
Langenbecks Arch Surg. 2000 Apr;385(3):179-84. doi: 10.1007/s004230050262.
Some primary and secondary liver tumours are not absolutely irresectable, but cannot be resected using a conventional approach because of the limited warm ischaemia tolerance of the liver or poor accessibility of the tumour region. In such situations, the techniques of ex vivo liver surgery, pioneered by Rudolf Pichlmayr some 10 years ago, offer new chances for R0 resection. All the three different approaches, namely "in situ"-, "ante situm"-, and "ex situ" resection, require the use of measures originally developed for transplantation, such as hypothermic liver perfusion and veno-venous bypass. They differ mainly in the extent to which major vessels are divided in order to achieve optimal mobility of the organ. The results show that radical resection can be achieved accomplished in many cases. If necessary, complex vascular reconstructions can be performed. Although perioperative morbidity and mortality are high, there are a number of long-term survivors. Tumour recurrence, however, remains the main problem over the long term. In conclusion, ex vivo liver surgery is an important extension of surgical treatment possibilities. However, the procedure is suitable only for a small number of carefully selected patients and should be reserved for use in specialised centres. Furthermore, in view of the fact that the results are not yet optimal, additive and adjuvant treatment modalities are needed.
一些原发性和继发性肝肿瘤并非绝对无法切除，但由于肝脏对热缺血的耐受性有限或肿瘤区域难以接近，无法采用传统方法进行切除。在这种情况下，大约10年前由鲁道夫·皮克尔迈尔开创的离体肝手术技术为R0切除提供了新的机会。所有三种不同的方法，即“原位”-、“先原位”-和“离体”切除，都需要使用最初为移植开发的措施，如低温肝灌注和静脉-静脉旁路。它们的主要区别在于为实现器官的最佳移动性而切断主要血管的程度。结果表明，在许多情况下可以实现根治性切除。如有必要，可以进行复杂的血管重建。虽然围手术期发病率和死亡率很高，但仍有一些长期存活者。然而，肿瘤复发仍然是长期的主要问题。总之，离体肝手术是手术治疗可能性的重要扩展。然而，该手术仅适用于少数经过精心挑选的患者，应保留在专门的中心使用。此外，鉴于结果尚未达到最佳，需要额外的和辅助的治疗方式。
