Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan.
Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan.
Gynecol Oncol. 2016 Mar;140(3):577-9. doi: 10.1016/j.ygyno.2016.01.017. Epub 2016 Jan 19.
Upper abdominal spreading of advanced-stage ovarian cancer often involves the diaphragm. In addition, bulky diaphragmatic tumors occasionally infiltrate the liver. Here, we describe our early experiences with a ventral liver mobilization technique to remove diaphragmatic tumors with liver involvement.
Two patients with primary ovarian cancer and 1 patient with recurrent ovarian cancer underwent en bloc resections of a diaphragmatic tumor together with the full-thickness diaphragm and the liver tissue using a ventral liver mobilization technique. The surgical technique involved a full-thickness division of the diaphragm at the central tendon and a ventral mobilization of the right lobe of the liver, with entry into the pleural cavity. During the parenchymal transection of the liver, the posterior area of the right lobe of the liver was pressed using the surgeon's hand to reduce bleeding from the resection surface. After the completion of the en bloc resection, the diaphragmatic opening was closed using running sutures.
All the diaphragmatic tumors were completely removed without severe bleeding in the current series. No intraoperative or postoperative complications occurred.
Diaphragmatic tumors with involvement of the liver can be safely and effectively removed using a ventral liver mobilization technique. This surgical procedure may be suitable for the management of bulky diaphragmatic tumors in select patients.
晚期卵巢癌的上腹部扩散常累及膈肌。此外，大体积的膈肌肿瘤偶尔会浸润肝脏。在这里，我们描述了我们使用腹侧肝脏游离技术切除合并肝脏受累的膈肌肿瘤的早期经验。
2 例原发性卵巢癌患者和 1 例复发性卵巢癌患者采用腹侧肝脏游离技术行整块膈肌肿瘤切除术，整块切除全层膈肌和肝组织。手术技术包括在中心腱处全层切开膈肌，并进行腹侧肝脏游离，进入胸腔。在肝实质横断过程中，用手按压右肝后区，减少肝切除面的出血。整块切除完成后，采用连续缝合关闭膈肌切口。
本系列中所有膈肌肿瘤均完整切除，无严重出血。无术中或术后并发症发生。
使用腹侧肝脏游离技术可安全有效地切除合并肝脏受累的膈肌肿瘤。这种手术方法可能适用于某些患者大体积膈肌肿瘤的治疗。
