Kurosawa Hisashi, Kimura Fumio, Ito Hiroshi, Shimizu Hiroaki, Togawa Akira, Otsuka Masayuki, Yoshidome Hiroyuki, Kato Atsushi, Miyazaki Masaru
Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, 260-8670, Chiba, Japan.
J Hepatobiliary Pancreat Surg. 2004;11(5):362-5. doi: 10.1007/s00534-004-0907-6.
Combined resection of the inferior vena cava for hepatobiliary malignancies remains a technical challenge. We successfully resected an intrahepatic cholangiocarcinoma involving the retrohepatic vena cava, and reconstructed the caval defect using a left renal vein patch graft. The patient was a 79-year-old man. Preoperative ultrasonography and computed tomography revealed that the tumor was located in the right lobe of the liver and was about 6 cm in diameter. Arteriogram revealed encasement of the right arterial and portal branches. Magnetic resonance imaging scan revealed that the tumor involved the retrohepatic vena cava. The patient underwent a right hepatectomy combined with resection of the retrohepatic vena cava. The resected portion of the caval wall was 3.6 cm long and 2.7 cm wide. The caval defect was reconstructed using a left renal vein patch graft of a rhomboid shape, which was made by oblique incision of the vein graft. The postoperative course was uneventful. Postoperative cavogram showed adequate patency of the reconstructed retrohepatic vena cava. The patient was disease-free 22 months after surgery. In conclusion, major liver resection combined with caval resection and reconstruction can be performed safely. Furthermore, a left renal vein graft can provide a flexible patch according to the form and size of the caval defect.
联合切除肝静脉治疗肝胆恶性肿瘤仍然是一项技术挑战。我们成功切除了累及肝后下腔静脉的肝内胆管癌，并使用左肾静脉补片移植修复了下腔静脉缺损。患者为一名79岁男性。术前超声和计算机断层扫描显示肿瘤位于肝右叶，直径约6厘米。动脉造影显示右动脉和门静脉分支被包绕。磁共振成像扫描显示肿瘤累及肝后下腔静脉。患者接受了右肝切除术联合肝后下腔静脉切除术。切除的下腔静脉壁部分长3.6厘米，宽2.7厘米。使用通过斜切静脉移植物制成的菱形左肾静脉补片移植修复下腔静脉缺损。术后过程顺利。术后腔静脉造影显示重建的肝后下腔静脉通畅良好。患者术后22个月无疾病复发。总之，联合肝脏大切除、下腔静脉切除和重建可以安全进行。此外，左肾静脉移植物可根据下腔静脉缺损的形状和大小提供灵活的补片。
