Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
J Hepatobiliary Pancreat Sci. 2013 Mar;20(3):313-23. doi: 10.1007/s00534-012-0525-7.
For patients with bulky liver tumors that have invaded all three hepatic veins at the hepatic venous confluence to the inferior vena cava (IVC), reconstruction of at least one hepatic vein outlet to the IVC is necessary.
To effectively treat these tumors, we performed 7 ante-situm liver resections. The ante-situm position provides surgeons with excellent visualization of the anatomical structures that should be maintained in the remnant liver. In addition, replacement of the involved IVC by a ringed expanded polytetrafluoroethylene (ePTFE) graft can be safely completed.
Because of the far-advanced malignancies of our 7 patients, the survival periods after surgery were limited, but the survival benefits of the procedure were not disappointing. From what has been reported in the literature, the survival periods in our patients appear to justify the employment of the procedure even when compared with survivals in patients who have less complex tumor extensions.
Because of the complexity of this procedure, a team of surgeons familiar with liver surgery and liver transplantation in a specialized hepatobiliary center is required. However, we anticipate that this procedure will be feasible and justified for selected patients in whom tumor invasion at the confluence of all three hepatic veins and the IVC is too extensive to treat with other surgical procedures.
对于侵犯肝静脉汇合处至下腔静脉（IVC）的所有三支肝静脉的大肝肿瘤患者，有必要重建至少一条通向 IVC 的肝静脉出口。
为了有效治疗这些肿瘤，我们进行了 7 例原位肝切除术。原位位提供了出色的解剖结构的可视化，这些结构应在残留肝脏中保持。此外，通过环形膨体聚四氟乙烯（ePTFE）移植物安全地完成受累 IVC 的置换。
由于我们的 7 名患者的恶性肿瘤已经远到晚期，手术后的生存时间有限，但该手术的生存获益并不令人失望。从文献报道来看，我们患者的生存时间似乎证明了即使与肿瘤扩展不那么复杂的患者相比，该手术的合理性。
由于该手术的复杂性，需要一支熟悉肝脏手术和肝脏移植的外科医生团队，在专门的肝胆中心。然而，我们预计对于那些肿瘤侵犯三支肝静脉汇合处和 IVC 的范围太广而无法用其他手术治疗的选定患者，该手术将是可行和合理的。
