Forni E, Meriggi F
Clinica Chirurgica Generale, Università degli Studi di Pavia.
G Chir. 1995 Oct;16(10):407-13.
Advances in hepatic transplantation have opened the possibility of bench surgery for liver disease. Thus, nonconventional methods such as the ex vivo approach (bench procedure) or the in vivo ex situ preserved liver surgery have been performed in selected cases. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection may not be sufficiently radical. To date, primary liver tumours (hepatocellular, cholangiocellular) and colo-rectal metastases are considered to be suitable conditions. The technique used is that of liver grafting. Hypothermic liver perfusion (U.W., 4 degrees C) and pump-driven veno-venous bypass from portal vein and inferior vena cava to the superior vena cava are performed. The principal aim of bench surgery is to avoid the unnecessary removal of a large amount of normal parenchyma. Resection lines follow the segmental structure of the liver. Sometimes, an atypical hepatectomy with a parenchymal exeresis "à la demande" is required. Authors' experience with four patients undergoing ex vivo operation of the liver (three patients) or surgery on an ex situ hypothermic perfused liver (one patient) is reported. The patients had liver metastases from colonic carcinoma (1 M, 2 F) and from renal carcinoma (1 M). Major hepatic resections were performed. One patient (M) died from neoplastic intestinal recurrence after 16 months. Two patients (F) died after 24 and 9 days for sepsis and pulmonary embolism. One patient (M) died intraoperatively from a massive retroperitoneal bleeding. Being able to remove otherwise unresectable hepatic neoplasms is a worthy objective. In the presence of diffuse chemoresistant colo-rectal hepatic metastases, liver bench surgery is a promising therapeutic hope. At the basis of a good hepatic function there are a correct organ preservation, a perfect bench surgical technique with respect for vascularization and biliary drainage of the hepatic remnant, and an accurate hemostasis of the resection surface.
肝移植技术的进步为肝脏疾病的离体手术开辟了可能性。因此，在某些特定病例中，已采用了非传统方法，如体外方法（离体手术）或体内原位低温灌注肝脏手术。这些方法仅限于其他情况下被认为无法治疗的病情和肿瘤阶段，或切除可能不够彻底的情况。迄今为止，原发性肝肿瘤（肝细胞性、胆管细胞性）和结直肠癌肝转移被认为是合适的适应症。所采用的技术是肝移植技术。进行低温肝脏灌注（UW液，4℃）以及从门静脉和下腔静脉到上腔静脉的泵驱动静脉-静脉旁路。离体手术的主要目的是避免不必要地切除大量正常实质组织。切除线遵循肝脏的节段结构。有时，需要进行“按需”实质切除的非典型肝切除术。报告了作者对4例接受肝脏离体手术（3例）或原位低温灌注肝脏手术（1例）患者的经验。这些患者患有结肠癌肝转移（1例男性，2例女性）和肾癌肝转移（1例男性）。均进行了大范围肝切除术。1例患者（男性）在16个月后死于肿瘤性肠道复发。2例患者（女性）分别在术后24天和9天死于败血症和肺栓塞。1例患者（男性）术中死于大量腹膜后出血。能够切除原本无法切除的肝肿瘤是一个有价值的目标。在存在弥漫性化疗耐药性结直肠癌肝转移的情况下，肝脏离体手术是一个有前景的治疗希望。良好肝功能的基础在于正确的器官保存、尊重肝残余组织血管化和胆汁引流的完美离体手术技术，以及切除表面的精确止血。
