Ohwada Susumu, Takahashi Toru, Tsutsumi Hiroyuki, Kawate Susumu, Ohki Satoshi, Hamada Kunihiro
Department of Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
Hepatogastroenterology. 2008 May-Jun;55(84):903-6.
This paper reports the use of cardiopulmonary bypass with mild hypothermia for the successful en bloc resection of a hepatocellular carcinoma in a cirrhotic liver with a tumor thrombus extending into inferior vena cava (IVC) and to the right atrium (RA), often prolapsing the tricuspid valve. The patient was a 77-year-old woman with antibodies against hepatitis C virus (HCV) and a serum alpha-fetoprotein (AFP) concentration of 13,566ng/mL. Imaging showed a large tumor in the left lobe of the liver extending into the RA, which often was prolapsed the tricuspid valve to produce mitral valve regurgitation. To prevent intraoperative pulmonary thromboembolism, both cardiac arrest and hepatic vascular occlusion with mild hypothermia were applied. The RA and IVC tumor thrombus and left liver were resected in en bloc. The cardiac arrest and hepatic vascular exclusion times were 56 and 15 min, respectively. The operation took 11 h, and the total blood loss was 1,078mL. The resected specimen weighed 1,000g and the tumor measured 8.0 x 7.8cm.
本文报道了在体外循环轻度低温辅助下，成功地对一名肝硬化合并肝癌患者进行了整块切除手术。该患者的肿瘤血栓已延伸至下腔静脉（IVC）及右心房（RA），且常导致三尖瓣脱垂。患者为一名77岁女性，丙肝病毒（HCV）抗体阳性，血清甲胎蛋白（AFP）浓度为13,566ng/mL。影像学检查显示，肝脏左叶有一巨大肿瘤延伸至右心房，常导致三尖瓣脱垂并引起二尖瓣反流。为防止术中发生肺血栓栓塞，采用了心脏停搏和轻度低温下的肝血管阻断技术。整块切除了右心房和下腔静脉的肿瘤血栓以及左肝。心脏停搏时间和肝血管阻断时间分别为56分钟和15分钟。手术历时11小时，总失血量为1,078mL。切除标本重1,000g，肿瘤大小为8.0×7.8cm。
