Pichlmayr R, Gubernatis G, Lamesch P, Raygrotzki S, Hauss J
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1989:257-61.
Ex situ operations on the liver, a new surgical approach, and operations on a vascularly isolated and in situ hypothermic-perfused liver were performed in 12 patients. The indications for either approach were limited to patients for whom a conventional approach was impossible or seemed insufficiently radical. In one case a huge symptomatic focal nodular hyperplasia in segment IV became resectable only with the ex situ-technique. Our first experience showed that preoperative cholestasis is a high-risk factor for postoperative hepatic insufficiency; three patients with marked preoperative cholestasis died. In patients with good preoperative liver function these two approaches allow a more radical liver resection and are the only possibility for tumor resection in particular situations.
对12例患者实施了肝脏的异位手术、一种新的手术方法以及对血管隔离并原位低温灌注肝脏的手术。两种方法的适应症均限于传统方法无法实施或似乎不够彻底的患者。在1例患者中，仅通过异位技术才使IV段巨大的有症状局灶性结节性增生变得可切除。我们的初步经验表明，术前胆汁淤积是术后肝功能不全的高危因素；3例术前胆汁淤积明显的患者死亡。对于术前肝功能良好的患者，这两种方法可实现更彻底的肝切除术，并且是特定情况下肿瘤切除的唯一可能性。
