Removal of Hepatocellular Carcinoma Extending into the Right Atrium with Extracorporeal Circulation
Removal of Hepatocellular Carcinoma Extending into the Right Atrium with Extracorporeal Circulation
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体外循环切除延伸至右心房的肝细胞癌
DOI：
10.5754/hge09440
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发表时间：
2012-07-01
影响因子：
--
通讯作者：
Ming, Li Dong
中科院分区：
文献类型：
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作者：
Li, Shen Shun;Jian, Liang Li;Ming, Li Dong
肝细胞癌伴肿瘤血栓延伸至右心房是罕见的，且预后极差。手术曾被视为一种禁忌症，后来被视为一种缓解方法，以防止肺栓塞或心力衰竭等紧急情况。随着影像技术的进步，肝切除术和体外循环的广泛应用，传统的观点逐渐改变。对于肝功能储备充足且无远处转移的患者，建议手术治疗。在过去的四年中，我们经历了两例这样的患者，我们在心肺循环和肝全血排除的情况下同时切除了肝肿瘤和右心房肿瘤血栓。两个病人都活了下来。随访期间，1例患者6个月后因多发肺转移及肿瘤进展死亡。另一位患者术后4个月复发，接受化疗、射频消融、经导管动脉化疗栓塞等辅助治疗。38个月后，患者死于多发性转移和肝功能衰竭。
Hepatocellular carcinoma with tumor thrombus extending into the right atrium is rare and has an extremely poor prognosis. Surgery was once regarded as a contraindication, then as a palliative method to prevent emergencies such as pulmonary embolism or heart failure. With advances of imaging techniques, hepatectomy and widespread use of extracorporeal circulation, conventional viewpoint has gradually changed. For patients with adequate hepatic function reserve and no distant metastases, surgery is recommended. During the past four years, we experienced two such patients, for both of whom we simultaneously resected the hepatic tumor and tumor thrombus in the right atrium under cardiopulmonary circulation and total hepatic blood exclusion. Both of the patients survived the surgery. During the follow-up, one patient died 6 months later due to multiple lung metastases and tumor progression. The other patient experienced recurrence 4 months after surgery and underwent adjuvant treatment modalities including chemotherapy, radiofrequency ablation and transcatheter arterial chemoembolization. Thirty-eight months later, the patient died of multiple metastasis and hepatic failure.