Sherba A E, Efimov D Iu, Rummo O O
Khirurgiia (Mosk). 2014(10):39-44.
It was analyzed the results of treatment of 8 patients. Combined resection of liver and inferior vena cava was done in all cases. All resections of inferior vena cava were performed in combination with right-sided hemihepatectomy. Circular resection of inferior vena cava was done in 6 cases, tangential-in 2 cases. Allograft of donor inferior vena cava was used in 3 cases for reconstruction of inferior vena cava. Average duration of combined resection of liver and inferior vena cava was 675±189 min, average hemorrhage - 1800±1402 ml. The need for transfusion of packed red blood cells was 270±723 ml, the need for transfusion of fresh frozen plasma was 1105±636 ml. Post-resection liver failure according to criteria ISGLS developed in 3 patients (37.5%). Biliary complications such as biliary fistula and inconsistency of hepatico-jejunal anastomosis developed in 2 patients (25%). Hospital mortality was 12.5%. It is considered that resection of liver with inferior vena cava demands an experience in hepatobiliary surgery and/or liver transplantation. Surgeon must be ready to use total vascular isolation, hypothermic preservation and veno-venous bypass grafting. It allows to dilate an opportunity of resection liver surgery.
分析了8例患者的治疗结果。所有病例均行肝脏和下腔静脉联合切除术。所有下腔静脉切除术均与右侧半肝切除术联合进行。6例患者行下腔静脉环形切除术，2例患者行切线切除术。3例患者使用供体下腔静脉同种异体移植进行下腔静脉重建。肝脏和下腔静脉联合切除的平均时长为675±189分钟，平均出血量为1800±1402毫升。浓缩红细胞的输注量为270±723毫升，新鲜冰冻血浆的输注量为1105±636毫升。根据国际肝脏外科研究组（ISGLS）标准，3例患者（37.5%）术后发生肝衰竭。2例患者（25%）出现胆瘘和肝空肠吻合口不吻合等胆道并发症。医院死亡率为12.5%。认为肝脏与下腔静脉联合切除术需要有肝胆外科手术和/或肝移植方面的经验。外科医生必须做好准备采用全血管隔离、低温保存和静脉-静脉旁路移植术。这增加了肝脏切除术的机会。
