Ohwada S, Tanahashi Y, Kawashima Y, Satoh Y, Nakamura S, Kobayashi I, Ohya T, Ishikawa S, Ohtaki A, Iino Y
Second Department of Surgery, Gunma University School of Medicine, Japan.
Hepatogastroenterology. 1994 Apr;41(2):154-7.
This is a report on a 42-year-old woman with a tumor thrombus in the inferior vena cava and the right atrium caused by recurrent hepatocellular carcinoma. The tumor thrombus, which extended from the retrohepatic inferior vena cava into the right atrium close to the tricuspid valve was successfully resected using a cardiopulmonary bypass and total hepatic vascular exclusion. The cardiopulmonary bypass was established by cannulating the ascending aorta, the superior vena cava and the infrarenal vena cava, and was performed under moderate hypothermia and ventricular fibrillation. To reduce the duration of ventricular fibrillation, after the tumor thrombus had been removed from the right atrium into the suprahepatic inferior vena cava through the atriotomy, the atriotomy was closed. The intrapericardial or suprahepatic vena cava was then clamped. The caval tumor thrombus was removed using the total hepatic vascular exclusion technique through a vena cava incision. To reduce total hepatic vascular exclusion time the suprahepatic vena caval clamp was released after the caval tumor had been removed from the suprahepatic vena caval. The infrahepatic vena cava just below the hepatocaval junction was then clamped and the entire tumor thrombus was removed. The vena caval incision was closed without a prosthesis. The total hepatic vascular exclusion and vena caval exclusion times were 10 and 30 minutes, respectively. The ventricular fibrillation and total cardiopulmonary bypass times were 15 and 52 minutes, respectively. The operating time was 9 hours and 30 minutes and the total blood loss was 4,000 ml.
这是一份关于一名42岁女性的报告，该患者因复发性肝细胞癌导致下腔静脉和右心房出现肿瘤血栓。肿瘤血栓从肝后下腔静脉延伸至靠近三尖瓣的右心房，通过体外循环和全肝血管阻断成功切除。体外循环通过分别插管升主动脉、上腔静脉和肾下腔静脉建立，在中度低温和心室颤动下进行。为了缩短心室颤动时间，在通过心房切口将肿瘤血栓从右心房取出至上肝下腔静脉后，关闭心房切口。然后夹闭心包内或上肝静脉。通过下腔静脉切口，采用全肝血管阻断技术取出下腔静脉肿瘤血栓。为了缩短全肝血管阻断时间，在上肝下腔静脉肿瘤取出后松开上肝静脉夹。然后夹闭肝静脉汇合处下方的肝下腔静脉，取出整个肿瘤血栓。下腔静脉切口未使用人工血管进行缝合。全肝血管阻断时间和下腔静脉阻断时间分别为10分钟和30分钟。心室颤动时间和体外循环总时间分别为15分钟和52分钟。手术时间为9小时30分钟，总失血量为4000毫升。
