在结直肠肝转移第 8 节段扩大解剖切除术中重建双肝静脉

IF 2.3 4区 医学 Q3 ONCOLOGY
Katsuya Sakashita, Shimpei Otsuka, Katsuhiko Uesaka, Teiichi Sugiura
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引用次数: 0

摘要

背景肝静脉重建(HVR)有时是切除肝脏恶性肿瘤的必要手段,以确保手术切缘,同时保留残余肝功能(Nakamura 等人,1993 年)[1]。由于手术技术要求高、发病风险大,因此很少有多次 HVR 的报道(Wakabayashi 等人,1998 年)[2]。我们介绍了针对侵犯右肝静脉(RHV)和肝中静脉(MHV)的转移性肝肿瘤的双 HVR 手术。由于肝功能受损,不适合进行扩大右半肝切除术。因此,对第 8 节段进行了扩大解剖切除,并进行了双 HVR。肝脏被完全移动,RHV 和 MHV 被固定。解剖肝实质后,标本由 RHV 和 MHV 连接(图 1)。用右股浅静脉移植物解剖并重建 MHV,同时保持 RHV 的连接(Matsuki 等人,2021 年)[3]。使用四点支撑线在近侧后壁重建 MHV,然后重建前壁。吻合采用套叠缝合法。远端则使用两点支撑线。标本移除后,切除 RHV,并以同样的方式使用左颈内静脉移植进行重建(Hirono 等人,2014 年)[4]。结果患者术后第 14 天出院,无肝功能衰竭迹象。术后 6 个月进行的计算机断层扫描显示没有移植物闭塞(图 2)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Double hepatic vein reconstruction during extended anatomical resection of segment 8 for colorectal liver metastasis

Background

Hepatic vein reconstruction (HVR) is occasionally necessary for resecting hepatic malignancies to ensure surgical margins while preserving remnant liver function [1]. Reports of multiple HVR are rare due to the highly technical demanding procedure and high risk of morbidity [2]. We introduce our procedure of double HVR for metastatic liver tumors invading the right hepatic vein (RHV) and middle hepatic vein (MHV).

Methods

The patient was a 66-year-old man with colorectal liver metastasis in segment 8, invading RHV and MHV. Due to impaired liver function, extended right hemihepatectomy was unsuitable. Thus, extended anatomical resection of segment 8 with double HVR was performed. The liver was completely mobilized and the RHV and MHV were secured. After liver parenchyma dissection, the specimen was connected by RHV and MHV (Fig. 1). The MHV was dissected and reconstructed using a right superficial femoral vein graft while the RHV remained connected [3]. Reconstruction of the MHV was performed on the posterior wall of the proximal side, followed by the anterior wall, using 4-point supporting threads. Anastomosis was performed by the over-and-over suture method. On the distal side, two-point supporting threads were applied. After specimen removal, the RHV was resected and reconstructed in the same manner using a left internal jugular vein graft [4].

Results

The patient was discharged on postoperative day 14 with no signs of liver failure. Computed tomography performed six months after surgery revealed no graft occlusion (Fig. 2).

Conclusion

In appropriately selected patients, this technique may be a useful option for preserving the remnant liver function.

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来源期刊
Surgical Oncology-Oxford
Surgical Oncology-Oxford 医学-外科
CiteScore
4.50
自引率
0.00%
发文量
169
审稿时长
38 days
期刊介绍: Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.
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