Pichlmayr R, Bretschneider H J, Kirchner E, Ringe B, Lamesch P, Gubernatis G, Hauss J, Niehaus K J, Kaukemüller J
Klinik für Abdominal- und Transplantationschirurgie der Medizinischen Hochschule Hannover.
Langenbecks Arch Chir. 1988;373(2):122-6. doi: 10.1007/BF01262775.
A method for an ex situ operation of the liver is presented with the example of such an operation in a 40-year-old patient. With this operation bilateral liver metastases of a leiomyosarcoma--which were otherwise regarded as irresectable--were resected. Function of the liver after reimplantation was good. Liver protection was performed by perfusion with cardioplegic HTK-solution (Bretschneider). The techniques of liver ex- and implantation are based on the methods of liver transplantation. Extracorporal femoro-porto-axillary bypass for decompression of the inferior caval vein and portal vein was used throughout the anhepatic period of 6 h. It is supposed that the method described here--which according to the authors' knowledge has been performed for the first time in a patient--will open up new perspectives for the surgery of malignant and occasionally of benign tumors, if necessary also for other surgical liver diseases. As an additional possibility, in situ protection of the liver with consecutive operation of the bloodless liver in situ is discussed. This procedure will correspond for the most part to the ex situ technique described here.
本文以一名40岁患者的肝脏异位手术为例，介绍了一种肝脏异位手术方法。通过该手术，切除了平滑肌肉瘤的双侧肝转移灶，这些转移灶在其他情况下被认为无法切除。再植后肝脏功能良好。采用心脏停搏液HTK溶液（布雷施奈德）灌注进行肝脏保护。肝脏取出和植入技术基于肝移植方法。在6小时的无肝期全程使用体外股-门静脉-腋静脉旁路来减压下腔静脉和门静脉。据作者所知，这里描述的方法首次在患者身上实施，推测该方法将为恶性肿瘤以及偶尔为良性肿瘤的手术开辟新的前景，必要时也可为其他肝脏外科疾病的手术开辟新前景。作为一种额外的可能性，还讨论了肝脏原位保护并随后进行肝脏原位无血手术。该手术在很大程度上与这里描述的异位技术相对应。
