Shimahara Y, Yamaoka Y, Morimoto T, Ikai I, Yamamoto Y, Yamamoto N
Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1998 Apr;99(4):208-13.
Ex situ partial liver resection was performed in 2 patients with hepatocellular carcinoma (HCC) with Child A-liver cirrhosis that was untreatable by conventional liver resection techniques. In both cases, an extended left lobectomy was first performed, and then the autologous lateral segment was transplanted after removing segment 4 (or + a part of segment 5, 8) together with the tumor by the bench procedure. Although there might have been no difference in preoperative liver function in these cases, the postoperative course was quite different. The first case was successful with an uneventful postoperative course, but, the second case went into postoperative liver failure and the patient died of multiple organ failure on the 20th postoperative day. The cause of liver failure in the second case might be attributable to: 1) prolongation of cold preservation time for the bench procedure (196 min); or 2) over reduction of the native remnant liver (right lobe) due to resection of the huge tumor. In conclusion, the technique using ex situ partial liver resection and transplantation of the remnant section of the liver might be a useful method to extend surgical treatment for some cases of HCC untreatable by conventional liver resection. However, the indications should be carefully considered in each case, since graft damage can occur rapidly during the bench procedure due to combined liver cirrhosis.
对2例患有Child A级肝硬化且无法用传统肝切除技术治疗的肝细胞癌（HCC）患者进行了体外部分肝切除术。在这两例手术中，均首先进行了扩大左叶切除术，然后通过工作台操作将第4段（或 + 第5、8段的一部分）连同肿瘤一起切除后，移植自体外侧段。尽管这些病例术前肝功能可能没有差异，但术后病程却大不相同。第一例手术成功，术后病程平稳，但第二例术后发生肝衰竭，患者在术后第20天死于多器官功能衰竭。第二例肝衰竭的原因可能是：1）工作台操作的冷保存时间延长（196分钟）；或2）由于巨大肿瘤的切除，导致原位剩余肝脏（右叶）过度缩小。总之，采用体外部分肝切除及剩余肝段移植的技术可能是一种有用的方法，可扩大对一些无法用传统肝切除治疗的HCC病例的手术治疗范围。然而，由于合并肝硬化，在工作台操作期间移植物可能会迅速受损，因此每种情况都应仔细考虑其适应症。
