原发性肝细胞癌合并下腔静脉癌栓的外科治疗进展  

Progress in surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava

作　　者：彭淑牖[1] 曹佳胜 林辉[2] 陈灵华[2] 骆鹏 李江涛[1] 洪德飞[2] 梁霄[2] 张斌 刘愉 Peng Shuyou;Cao Jiasheng;Lin Hui;Chen Linghua;Luo Peng;Li Jiangtao;Hong Defei;Liang Xiao;Zhang Bin;Liu Yu(Department of General Surgery,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of General Surgery,Sir Run-Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Cardiac Surgery,Sir Run-Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属第二医院普外科,杭州310009 [2]浙江大学医学院附属邵逸夫医院普外科,杭州310016 [3]浙江大学医学院附属邵逸夫医院心脏外科,杭州310016

出　　处：《中华外科杂志》2023年第10期821-825,共5页Chinese Journal of Surgery

基　　金：浙江省自然科学基金(LQ23H160036)。

摘　　要：原发性肝细胞癌是消化系统的常见恶性肿瘤, 易侵犯微血管及大血管系统。在肝细胞癌累及大血管系统患者中, 合并下腔静脉癌栓(IVCTT)或右心房癌栓(RATT)为较少见的肿瘤疾病状态, 患者预后极差, 且针对此类患者的外科治疗目前多为散在报道。本文对原发性肝细胞癌合并IVCTT或RATT的癌栓分型进行阐述, 就外科手术方式进展与外科手术操作进展进行综述, 并结合自身外科经验介绍非体外循环下从心房外推出RATT进入下腔静脉后取栓的临床经验, 希望为肝细胞癌合并IVCTT或RATT的治疗提供参考。Hepatocellular carcinoma(HCC)is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion.Among them,HCC with inferior vena cava tumor thrombus(IVCTT)or right atrium tumor thrombus(RATT)is rare and has a poor prognosis.However,surgical treatment of HCC with IVCTT and(or)RATT is rarely reported and summarized.The review described the classification of HCC tumor thrombus with IVCTT and(or)RATT,summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass.The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

关 键 词：肝肿瘤 外科手术 下腔静脉癌栓 右心房癌栓 从心房外推出癌栓 

分 类 号：R735.7[医药卫生—肿瘤]