Mizuno Shugo, Yagihara Masahiro, Tanemura Akihiro, Kuriyama Naohisa, Azumi Yoshinori, Kishiwada Masashi, Ohsawa Ichiro, Usui Masanobu, Sakurai Hiroyuki, Tabata Masami, Miyabe Masayuki, Isaji Shuji
Hepatogastroenterology. 2013 Sep;60(126):1409-12. doi: 10.5754/hge121321.
BACKGROUND/AIMS: For resection of advanced liver tumors with tumor thrombus/invasion extending into the intra-thoracic inferior vena cava (IVC) above the diaphragm as well as huge liver tumors located at the root of hepatic vein, an appropriate approach to the intra-thoracic IVC through the abdominal cavity is the key to control the intraoperative massive bleeding.
The pericardium and diaphragm are separated by using fingers without injury of the pericardium. From just below the xiphoid process to the IVC, the diaphragm is vertically dissected without cutting the pericardium and doing median sternotomy. Then the intra-thoracic IVC is exposed easily and encircled with an umbilical tape.
This technique was applied in four patients (hepatocellular carcinoma: n = 3, cholangiocellular carcinoma: n = 1). The mean patient's age was 69 (59-81) year old, and three were male. The median duration of surgery and blood loss was 490 min and 3600 mL, respectively. The median peaked aspartate aminotransferase and total bilirubin was 428 IU/mL and 2.75 mg/dL, respectively. The median duration of hospital stay was 22 days.
This approach to intra-thoracic IVC through the abdominal cavity is very beneficial and helpful for many liver surgeons.
背景/目的：对于切除肿瘤血栓/侵犯延伸至膈上胸段下腔静脉（IVC）的晚期肝肿瘤以及位于肝静脉根部的巨大肝肿瘤，经腹腔进入胸段IVC的合适方法是控制术中大量出血的关键。
用手指分离心包和膈肌，避免损伤心包。从剑突下至IVC，垂直切开膈肌，不切开心包且不行胸骨正中切开术。然后可轻松暴露胸段IVC并用脐带线环绕。
该技术应用于4例患者（肝细胞癌：3例，胆管细胞癌：１例）。患者平均年龄69（59 - 81）岁，男性3例。手术中位时长和失血量分别为490分钟和3600毫升。天门冬氨酸氨基转移酶和总胆红素峰值中位数分别为428 IU/mL和2.75 mg/dL。住院中位时长为22天。
这种经腹腔进入胸段IVC的方法对许多肝脏外科医生非常有益且有帮助。
