Funamizu Naotake, Mishima Kohei, Ozaki Takahiro, Nakanishi Kazuma, Igarashi Kazuharu, Omura Kenji, Takada Yasutsugu, Wakabayashi Go
Department of Surgery, Ageo Central General Hospital, Ageo City, Saitama Prefecture, Japan.
Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Toon City, Ehime Prefecture, Japan.
Ann Surg Oncol. 2021 Mar;28(3):1511-1512. doi: 10.1245/s10434-020-09019-y. Epub 2020 Aug 15.
Laparoscopic liver resection has been increasingly utilized due to its less invasiveness approach compared with open surgery,13 but often creates challenges. Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) portends a poorer prognosis and often precludes patients from potential liver resection.46 We herein report a case of laparoscopic hepatectomy and thrombectomy in a patient with HCC and BDTT.
CT, ERCP, and POCS showed a 40-mm tumor located in the right lobe with BDTT. A five 12-mm trocar was inserted at the umbilicus for laparoscope, the epigastrium, both sides of the hypochondrium, and right lateral region. Moreover, a 5-mm trocar was inserted at left hypochondrium. After cholecystectomy, hepatoduodenal ligament was encircled using the tourniquet through 5-mm trocar site. The right portal vein was transected by stapler following transection of the right hepatic artery. After ICG staining (0.5 mg/body i.v.),7 hepatic parenchymal transection was performed using clamp-crashing technique. Moreover, CUSA also was used near Glissonian sheath. BDTT was removed from the right BD. Moreover, the cholangioscopy confirmed no BDTT remnants. The resection stump was then sutured. Finally, the right hepatic vein was divided with a stapler. A drainage tube was placed in the right subphrenic space. Operation time was 496 min, and blood loss was 91 ml. The patient was discharged without complications on postoperative day 11. Pathological diagnosis showed moderately differentiated HCC, tumor size 40 × 45 mm with negative surgical margins.
Pure laparoscopic resection for HCC with BDTT is a radical, yet feasible procedure.
与开放手术相比，腹腔镜肝切除术因其侵入性较小的手术方式而得到越来越广泛的应用，但它也常常带来挑战。伴有胆管癌栓（BDTT）的肝细胞癌（HCC）预后较差，并且常常使患者无法接受潜在的肝切除术。我们在此报告1例腹腔镜肝切除术联合癌栓切除术治疗HCC合并BDTT患者的病例。
CT、ERCP和POCS显示右叶有一个40mm的肿瘤并伴有BDTT。在脐部插入一个12mm的套管用于腹腔镜操作，在中上腹、双侧季肋部和右外侧区域分别插入12mm套管。此外，在左季肋部插入一个5mm套管。胆囊切除术后，通过5mm套管部位用止血带环绕肝十二指肠韧带。在切断右肝动脉后，用吻合器切断右门静脉。经静脉注射吲哚菁绿（ICG，0.5mg/体质量）后，采用钳夹挤压技术进行肝实质离断。此外，在肝门部鞘管附近也使用了CUSA。从右胆管取出BDTT。此外，胆道镜检查确认无BDTT残留。然后缝合切除残端。最后，用吻合器切断右肝静脉。在右膈下间隙放置一根引流管。手术时间为496分钟，出血量为91ml。患者术后第11天出院，无并发症。病理诊断为中分化HCC，肿瘤大小40×45mm，手术切缘阴性。
单纯腹腔镜切除治疗HCC合并BDTT是一种根治性且可行的手术。
