保留下腔静脉的离体低温右肝扩大切除治疗不可切除IV型肝门部胆管癌

目的:探讨保留下腔静脉的离体低温肝切除治疗不可切除Ⅳ型肝门部胆管癌的效果.方法:回顾性分析2例Ⅳ型肝门部胆管癌患者临床资料,其中1例行保留下腔静脉的原位低温灌注扩大右肝切除术,另1例采用保留下腔静脉的全离体扩大右肝切除治疗.结果:原位低温灌注扩大右肝切除术历时14h,术中输血3 000 mL,然而,患者术后第1天死于多器官功能衰竭.全离体扩大右肝切除术历时15h,术中输血2 000 mL,热缺血时间20 min,冷缺血时间195 min,术后30d出院,无肝衰和其他重大并发症发生,随访11个月,患者仍然存活且无血管、胆管并发症及肿瘤复发和转移.结论:在有复杂肝切除经验和活体肝移植经验的前体下,保留下腔静脉的离体低温肝切除是安全的,且可能是治疗精选的不可切除Ⅳ型肝门部胆管癌的有效选择.

Ex vivo hypothermic extended right hepatectomy with caval preservation for irresectable Bismuth type IV hilar cholangiocarcinoma

Objective: To evaluate the efficacy of ex vivo hypothermic liver resection with caval preservation for irresectable Bismuth type IV hilar cholangiocarcinoma. Methods: The clinical records of two patients with Bismuth type IV hilar cholangiocarcinoma were reviewed. One of the two patients underwent in situ hypothermic extended right hepatectomy with of caval flow preservation, and the other one received complete ex vivo extended right liver resection with vena cava preservation. Results: The surgical duration of in situ hypothermic extended right hepatectomy lasted 14 h, and the intraoperative blood transfusion was 3 000 mL, however, the patient died due to multiple organ failure on the first day after surgery. The surgical procedure for ex vivo extended right liver resection took 15 h, and the blood transfusion requirement was 2 000 mL, with a cold ischemic time of 195 min, and a warm ischemic time of 20 min. This patient was discharged on postoperative day 30 with no occurrence of liver failure or other major complications, and was still alive with no evidence of vascular or biliary complications and no tumor recurrence or metastases during the 11-month follow-up period. Conclusion: Based on the premise of having wide experience in performing complex liver resection and living donation liver transplantation, the operation of ex vivo hypothermic extended right hepatectomy with caval preservation is safe, and it may be a therapeutic option for highly selected irresectable Bismuth type IV hilar cholangiocarcinoma.