Emre S, Schwartz M E, Katz E, Miller C M
Department of Surgery, Mount Sinai School of Medicine, New York, New York.
Ann Surg. 1993 Jan;217(1):15-9. doi: 10.1097/00000658-199301000-00004.
Total vascular isolation (TVI) of the liver was employed during parenchymal transection in 16 patients undergoing hepatic resection for large tumors (mean diameter, 10.7 cm) located near hilar structures, hepatic veins, or the inferior vena cava (IVC). In 14 cases, TVI was achieved by clamping the suprahepatic and infrahepatic IVC and the porta hepatis, with or without aortic occlusion; in two, selective hepatic vein clamping was possible, obviating IVC occlusion. Procedures included standard and extended right and left lobectomies and caudate lobe resections. Concomitant resection and reconstruction of the portal vein (one case), IVC (one case), and bile duct (three cases) was required. Postoperative hepatic and renal failure did not occur. Mean intensive care unit and hospital stays were 2.8 +/- 1.9 and 12.5 +/- 5.2 days, respectively. There were two perioperative deaths. Total vascular isolation permits safe resection of large, critically located tumors that would otherwise present prohibitive operative risks.
16例因靠近肝门结构、肝静脉或下腔静脉（IVC）的大肿瘤（平均直径10.7 cm）接受肝切除的患者，在实质离断过程中采用了肝脏全血管隔离（TVI）技术。14例患者通过钳夹肝上下腔静脉、肝下下腔静脉和肝门实现了TVI，可选择性地阻断或不阻断主动脉；2例患者可行选择性肝静脉钳夹，避免了下腔静脉阻断。手术包括标准和扩大的左右肝叶切除术及尾状叶切除术。1例患者需同时行门静脉切除重建，1例患者需行下腔静脉切除重建，3例患者需行胆管切除重建。术后未发生肝衰竭和肾衰竭。重症监护病房平均住院时间和总住院时间分别为2.8±1.9天和12.5±5.2天。围手术期死亡2例。全血管隔离可安全切除位置关键的大肿瘤，否则手术风险极高。
