Shi Shu-Jun, Wang Deng-Liang, Hu Wei, Peng Fei, Kang Quan
Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China.
Pediatr Transplant. 2018 Nov;22(7):e13268. doi: 10.1111/petr.13268. Epub 2018 Jul 12.
Some primary and secondary liver carcinomas cannot be resected using a conventional approach due to their size, location, or major vascular invasion. The aim of this study was to explore the application of ex vivo liver resection and autotransplantation for complicated HB in children. A 1.5-year-old girl with HB after repeated chemotherapy was analyzed. In this patient, tumor invasion includes the IV, V, and VIII liver segments, and thrombosis formed in the inferior vena cava and right atrium. It is difficult to obtain complete tumor resection using conventional hepatectomy. The patient was treated via ex vivo liver resection and autotransplantation, and tumor thrombus in the inferior vena cava and right atrium was removed via cardiopulmonary bypass. Operative methods and precautions were analyzed during and after the operation. The operation was completed successfully within 8 hours, and the liver's cold ischemia time was 190 minutes. The patient recuperated successfully, and the liver's function and AFP levels gradually tended to normalize 2 weeks after the operation. Ultrasonic examination revealed that the blood flow velocity of the hepatic vein, portal vein, and hepatic artery was good. The patient recovered and was discharged 3 weeks after the operation. Ex vivo liver resection and autotransplantation have great application value for complicated HB in children that is not suitable for conventional hepatic lobectomy.
一些原发性和继发性肝癌由于其大小、位置或主要血管侵犯，无法采用传统方法切除。本研究的目的是探讨离体肝切除和自体肝移植在儿童复杂性肝母细胞瘤（HB）中的应用。分析了一名1.5岁反复化疗后患有HB的女孩。在该患者中，肿瘤侵犯包括肝IV、V和VIII段，下腔静脉和右心房形成血栓。采用传统肝切除术难以实现肿瘤的完整切除。该患者接受了离体肝切除和自体肝移植治疗，并通过体外循环清除了下腔静脉和右心房的肿瘤血栓。分析了手术过程中和手术后的手术方法及注意事项。手术在8小时内成功完成，肝脏冷缺血时间为190分钟。患者康复顺利，术后2周肝脏功能和甲胎蛋白水平逐渐趋于正常。超声检查显示肝静脉、门静脉和肝动脉血流速度良好。患者术后3周康复出院。离体肝切除和自体肝移植对于不适合传统肝叶切除术的儿童复杂性HB具有很大的应用价值。
