Hwang Shin, Ko Gi-Young
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2020 May 31;24(2):174-181. doi: 10.14701/ahbps.2020.24.2.174.
Deprivation of portal blood flow decreases the hepatic function, thus hepatobiliary cancer patients with total occlusion of the main portal vein (PV) are usually not indicated for major hepatectomy. We herein present a 37-year-old male patient with advanced intrahepatic cholangiocarcinoma, in whom right trisectionectomy was indicated. However, the main PV was nearly completely occluded by tumor invasion, thus resolution of jaundice was markedly slow. To restore the liver function through PV recanalization, a wall stent was inserted percutaneously. Jaundice resolved progressively after PV stenting. Right trisectionectomy, caudate lobectomy, bile duct resection, and en bloc PV segmental resection with iliac vein homograft interposition were performed. However, PV thrombosis developed at the site of PV stent removal, thus a new wall stent was inserted during the operation. The pathology report presented that the tumor was a 5.2 cm-sized well-differentiated adenocarcinoma of periductal infiltrating type with lymph node metastasis. During the follow-up, the interposed PV segment with a wall stent was gradually occluded with development of portal collaterals. At 5 years after surgery, the PV stent was completely occluded and collaterals developed. The patient experienced repetition of febrile episodes of unknown causes. He is currently alive for 8 years with no evidence of tumor recurrence. The detailed surgical procedures were presented with a supplementary video clip of 5 minutes.
门静脉血流阻断会降低肝功能，因此，主要门静脉（PV）完全闭塞的肝胆癌患者通常不适合进行大范围肝切除术。我们在此报告一名37岁患有晚期肝内胆管癌的男性患者，对其实施了右半肝切除术。然而，主要PV因肿瘤侵犯几乎完全闭塞，因此黄疸消退明显缓慢。为通过PV再通恢复肝功能，经皮插入了一个壁式支架。PV置入支架后黄疸逐渐消退。实施了右半肝切除术、尾状叶切除术、胆管切除术以及带髂静脉同种异体移植插入的PV节段整块切除术。然而，在PV支架移除部位发生了PV血栓形成，因此在手术过程中插入了一个新的壁式支架。病理报告显示肿瘤为一个5.2厘米大小、高分化的导管周围浸润型腺癌，伴有淋巴结转移。在随访期间，带壁式支架的置入PV节段随着门静脉侧支循环的形成逐渐闭塞。术后5年，PV支架完全闭塞且侧支循环形成。患者经历了不明原因的发热发作反复。他目前存活8年，无肿瘤复发迹象。详细的手术过程配有一个5分钟的补充视频片段展示。
