Case series of extended liver resection associated with inferior vena cava reconstruction using peritoneal patch
Case series of extended liver resection associated with inferior vena cava reconstruction using peritoneal patch
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DOI：
10.1016/j.ijsu.2020.05.069
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发表时间：
2020-08-01
影响因子：
15.3
通讯作者：
Soubrane, O.
中科院分区：
文献类型：
--
作者：
Hobeika, C.;Cauchy, F.;Soubrane, O.
简介：在各种报道的下腔静脉（IVC）重建技术中，一种技术相对于另一种技术的优越性尚未明确确定。本研究旨在报告扩大肝切除期间使用腹膜补片重建腔静脉的技术问题。方法：本研究纳入了2016年至2019年所有连续接受扩大肝切除并使用腹膜补片重建前外侧腔静脉的患者。报告了技术见解、术中细节、短期和长期结果。结果：总共 6 名患者在全血管排除下使用腹膜补片进行了腔静脉重建。其中一半需要静脉-静脉搭桥术。腔静脉受累范围为下腔静脉周长的 30% 至 50%，长度为 5 至 7 厘米。腔静脉重建使用从四例镰状韧带采集的腹膜补片以及各一例从右肾前腹膜和膈肌右侧部分采集的腹膜补片进行。 3 例患者接受了残余肝静脉联合再植术。中位术中失血量和 TVE 持续时间分别为 500 毫升和 41 分钟。 1 例出现严重并发症（肝功能衰竭导致死亡）。所有患者均实现 R-0 切除。所有患者在最后一次随访时均具有开放的下腔静脉和残余肝静脉，并且没有人接受长期抗凝治疗。结论：在接受扩大肝切除术的患者中使用腹膜补片进行腔静脉重建是可行的且具有成本效益，并且具有良好的长期结果。
Introduction: Among various reported techniques for inferior vena cava (IVC) reconstruction, the superiority of one technique over another has not been clearly established. This study aimed at reporting the technical aspects of caval reconstruction using peritoneal patch during extended liver resections.Methods: All consecutive patients who underwent extended liver resection associated with anterolateral caval reconstruction using a peritoneal patch from 2016 to 2019 were included in this study. Technical insights, intraoperative details, short and long-term results were reported.Results: Overall six patients underwent caval reconstruction using peritoneal patch under total vascular exclusion. Half of them required veno-venous bypass. Caval involvement ranged from 30 to 50% of the circumference and from 5 to 7 cm of the length of the IVC. Caval reconstructions was performed using a peritoneal patch harvested from the falciform ligament in four cases and from the right pre-renal peritoneum and right part of the diaphragm in one Case each. Three cases underwent associated reimplantation the remnant hepatic vein. Median intra-operative blood loss and TVE duration were 500 ml and 41 min, respectively. One case experienced a severe complication (liver failure leading to death). R-0 resection was achieved in all patients. All patients had patent IVC and remnant hepatic vein at last follow-up and none was on long-term therapeutic anticoagulation.Conclusion: Caval reconstruction using a peritoneal patch in patients undergoing extended liver resection is feasible and cost-effective and associated with excellent long-term results.