Hannoun L, Balladur P, Delva E, Panis Y, Camus Y, Honiger J, Levy E, Parc R
Service de Chirurgie Digestive, INSERM, Hôpital Saint-Antoine, Paris.
Gastroenterol Clin Biol. 1991;15(10):758-61.
Major liver resections with complex vascular reconstruction require ischemia lasting from 2 h 30 to 5 h thus exceeding hepatic tolerance to warm ischemia. We describe a new technique of "ex situ-in vivo" liver surgery with prolonged ischemia with an intact hepatic pedicle. The surgical procedure encompasses complete mobilization of the liver and inferior vena cava, inferior mesenteric and femoral to axillary vein bypass, complete vascular exclusion of the liver, cold perfusion (U. W. solution), section of the hepatic veins allowing exteriorization of the liver ("ex situ") which remains connected by the hepatic pedicle ("in vivo"). The liver is placed on a heat exchanger at 4 degrees C. This procedure was performed in three patients: one each with hepatocellular carcinoma, huge metastasis of colorectal carcinoma and a "diffuse" hemangioma. Duration of ischemia was 225, 205, and 230 min respectively. The postoperative course was uneventful in all 3 cases and patients are alive at 15, 12, and 6 months. As it improves resecability rate of liver tumors and provides radical margins of resection, this procedure may be a beneficial alternative to liver transplantation for which poor results in cancer therapy with a high rate of recurrence are mainly due to immunosuppression.
需要进行复杂血管重建的大型肝切除术，其缺血时间长达2小时30分钟至5小时，因而超出了肝脏对热缺血的耐受程度。我们描述了一种新的“体外-体内”肝脏手术技术，可在肝蒂完整的情况下延长缺血时间。手术过程包括肝脏和下腔静脉的完全游离、肠系膜下静脉至股静脉再至腋静脉的搭桥、肝脏的完全血管阻断、冷灌注（UW液）、肝静脉离断以使肝脏能移出体外（“体外”），但肝脏仍通过肝蒂相连（“体内”）。将肝脏置于4摄氏度的热交换器上。该手术在3例患者中实施：分别为1例肝细胞癌、1例结直肠癌巨大转移灶和1例“弥漫性”血管瘤患者。缺血时间分别为225分钟、205分钟和230分钟。所有3例患者术后病程均顺利，患者分别在术后15个月、12个月和6个月时仍存活。由于该手术提高了肝脏肿瘤的可切除率并提供了根治性切缘，对于肝移植而言，这可能是一种有益的替代方法，肝移植在癌症治疗中效果不佳且复发率高，主要是由于免疫抑制。
