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肝切除联合下腔静脉切除及人工血管移植重建:文献综述

Liver resection combined with inferior vena cava resection and reconstruction using artificial vascular graft: A literature review.

作者信息

Tomimaru Yoshito, Eguchi Hidetoshi, Wada Hiroshi, Doki Yuichiro, Mori Masaki, Nagano Hiroaki

机构信息

Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Suita Japan.

Department of Gastroenterological Surgery Toyonaka Municipal Hospital Toyonaka Japan.

出版信息

Ann Gastroenterol Surg. 2018 Apr 15;2(3):182-186. doi: 10.1002/ags3.12068. eCollection 2018 May.

Abstract

In cases where liver tumors invade the inferior vena cava (IVC), IVC resection along with liver resection may be needed to effect a cure. Furthermore, if the IVC defect is large, IVC reconstruction with vascular graft after resection is required. There are limited reports of cases of IVC reconstruction using a graft. By reviewing data from the literature of previous studies, the present study was aimed at investigating the surgical outcomes of liver resection with IVC resection and reconstruction using an artificial vascular graft. PubMed was searched for previous articles reporting cases with the combined surgery. The search was limited to articles in English, and cases with exceptional surgeries such as in situ cold perfusion, and ante situm and ex vivo techniques were excluded from this study. Surgical outcomes of the extracted cases were investigated. Cases dealt only with primary closure after IVC resection, and those in which the IVC tumor thrombus was treated by opening the IVC wall, removing the thrombus and then closing the IVC without wall excision were not included in this study. The literature search identified 13 studies, including 111 cases. Operative mortality in the reported cases was 8.1% (9 out of 111 cases). Thrombus in the artificial vascular graft was observed in two cases, and patency of the graft during the follow-up period was confirmed in 109 of the 111 cases (98.2%). These results suggested that the surgical outcomes of liver resection combined with IVC resection and reconstruction using the artificial vascular graft were favorable.

摘要

在肝肿瘤侵犯下腔静脉(IVC)的病例中,可能需要同时进行IVC切除和肝切除才能实现治愈。此外,如果IVC缺损较大,则需要在切除后用血管移植物进行IVC重建。关于使用移植物进行IVC重建的病例报道有限。通过回顾以往研究的文献数据,本研究旨在调查采用人工血管移植物进行IVC切除和重建的肝切除手术效果。在PubMed上搜索以前报道联合手术病例的文章。搜索仅限于英文文章,本研究排除了原位冷灌注、原位和体外技术等特殊手术的病例。对提取病例的手术效果进行了调查。本研究不包括仅在IVC切除后进行一期缝合的病例,以及通过打开IVC壁、清除血栓然后在不切除壁的情况下关闭IVC来治疗IVC肿瘤血栓的病例。文献检索确定了13项研究,包括111例病例。报道病例的手术死亡率为8.1%(111例中有9例)。人工血管移植物中观察到血栓的病例有2例,111例中有109例(98.2%)在随访期间移植物通畅。这些结果表明,采用人工血管移植物进行IVC切除和重建联合肝切除的手术效果良好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ca1/5980586/05a1e6ce9d88/AGS3-2-182-g001.jpg

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