Belghiti J, Dousset B, Sauvanet A, Lipinska E, Aschehoug J, Fékété F
Service de Chirurgie Digestive, Hôpital Beaujon, Université Paris VII, Clichy.
Gastroenterol Clin Biol. 1991;15(5):449-53.
We report 3 cases of liver tumors which were unsuitable for conventional resection and which were removed using a technique combining hypothermic portal perfusion with an anhepatic period of more than 2 hours. The liver was mobilized after section of the infra- and supra-hepatic inferior vena cava in 2 cases. The tumor was a cholangiocarcinoma in 2 cases and colonic metastasis in 1 case. Non-tumoral liver parenchyma was normal in all cases. The inferior vena cava was involved by the tumor in 2 cases. Complete tumor resection was achieved in all cases, but required reconstruction of the hepatic veins in 1 case. Two patients in whom portal venous bypass was not used developed hemodynamic failure after liver revascularization. One of them died. In patients without underlying chronic liver disease and with unresectable tumor by conventional technique, "ex situ" resection can be a worthwhile therapeutic alternative.
我们报告了3例不适用于传统切除术的肝肿瘤病例，这些病例采用了低温门静脉灌注与超过2小时的无肝期相结合的技术进行切除。2例患者在切断肝上下腔静脉后游离肝脏。2例肿瘤为胆管癌，1例为结肠转移瘤。所有病例的非肿瘤性肝实质均正常。2例患者的下腔静脉受肿瘤侵犯。所有病例均实现了肿瘤的完全切除，但1例需要重建肝静脉。2例未采用门静脉旁路的患者在肝脏再灌注后出现血流动力学衰竭。其中1例死亡。对于无潜在慢性肝病且传统技术无法切除肿瘤的患者，“原位”切除可能是一种值得尝试的治疗选择。
