人造血管重建下腔静脉活体肝移植治疗超米兰标准肝癌的临床应用价值  

Clinical application of LDLT after reconstruction of IVC using artificial blood vessel in the treatment of HCC beyond Milan Criteria

作　　者：孙倍成 李国强[1] 黄新立[1] 秦建杰[1] 母小新[1] Sun Beicheng, Li Guoqiang, Huang Xinli, Qin Jianjie, Mu Xiaoxin Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China E Sun BC(Currently address： Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China） ] ; Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanfing 210029, Chi)

机构地区：[1]南京医科大学第一附属医院肝移植中心,210029 [2]南京大学医学院附属鼓楼医院肝胆外科,210008

出　　处：《中华肿瘤杂志》2018年第3期211-215,共5页Chinese Journal of Oncology

基　　金：国家重点研发计划精准医学研究重点专项（2016YFC0905900）

摘　　要：目的探讨人造血管替代肝后下腔静脉在右半肝活体肝移植手术治疗超出米兰标准肝癌中的应用价值。方法回顾性分析2015年6月至2016年11月在南京医科大学第一附属医院肝移植中心，利用人造血管替代肝后下腔静脉行右半肝肝移植的9例肝癌患者的临床资料。病肝连同肝后下腔静脉被移除，供肝植入采用经典原位肝移植术。结果9例肝癌患者的肝移植手术均获得成功。供肝静脉流出道重建时间为（22.6±3.0）min，无肝时间为（45.0±7.1）min，总手术时间为（321.9±52.5）min。患者术后恢复顺利，术后ICU治疗时间和总住院时间分别为（1.2±0.4）d和（18.4±3.0）d。患者术后并发人造血管血栓2例，1例经保守治疗好转，1例放置血管支架；胆瘘1例，经保守治疗好转；无腹腔感染、肺部感染、非人造血管血栓等并发症，无围手术期死亡病例。9例患者的术后病理结果均为肝细胞癌，肿瘤直径为（9.7±3.6）cm。9例患者均获得随访，1例患者术后10个月因肺转移和脑转移死亡，1例患者术后12个月肝脏局部复发带瘤生存，其余患者均未见肿瘤复发和转移。结论人造血管替代肝后下腔静脉在肝癌行肝移植手术治疗中安全、可行，能提高病肝切除率和肝癌患者活体肝移植的预后。ObjectiveTo assess application of reconstruction of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation （LDLT） in the treatment of hepatocellular carcinoma （HCC） beyond Milan Criteria.MethodsThe clinical data of 9 HCC patients who underwent right lobe liver transplantation after reconstruction of retrohepatic inferior vena cava using artificial blood vessel between June 2015 and Nov 2016 at Liver Transplantation Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The liver of the patients was removed with retrohepatic inferior vena cava, and then the right donor graft was implanted by conventional orthotopic liver transplantation.ResultsAll 9 liver transplantations were performed successfully. The time of reconstruction of hepatic venous outflow of the donor graft was （22.6±3.0） min, anhepatic time was （45.0±7.1） min, and total operation time was （321.9±52.5） min. All patients recovered uneventfully, ICU and hospital stay day were （1.2±0.4） days and （18.4±3.0） days. 2 patients suffered from thrombosis of artificial blood vessel, one recovered after conservative treatment and another was treated by placement of vein stent. No abdominal/pulmonary infection and non-artificial blood vascular complications were found, and none died in perioperative period. Postoperative pathological results showed that all patients were hepatocellular carcinomas and vascular tumor thrombosis was found in 5 cases. All patients were follow up, 1 patient died of pulmonary and brain metastasis 10 months after operation. One patient survived with local recurrence of tumor in liver. The other patients had no tumor recurrence and metastasis.ConclusionReplacement of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation is safe and feasible in the treatment of HCC beyond Milan Criteria, and might improve the resection rate of diseased liver and the

关 键 词：癌 肝细胞 人造血管 肝后下腔静脉 右半肝 活体肝移植 

分 类 号：R735.7[医药卫生—肿瘤]