Hepatic Resection Using in-situ Cold Perfusion Under Total Vascular Exclusion

位于下腔静脉或主肝静脉附近的肝肿瘤被认为是不能手术的，因为除非完全阻断血管，否则这些静脉的撕裂会产生无法控制的出血。本研究通过犬在体冷灌流实验，以动脉-酮体比(AKBR)评价UW液作为灌流液的优越性。在一位右叶靠近下腔静脉的巨大肿瘤患者中，我们应用了这种方法。完全阻断门静脉后，从门静脉左支注入冷的乳酸林格液，在下腔静脉上开一个小孔作为出口。肝切除、下腔静脉和肝静脉重建均顺利完成，无出血。AKBR再灌流至肝脏后恢复迅速且充足。使用这种方法，未来肝肿瘤的可切除性将会增加。

The hepatic tumors localized close to the IVC or main hepatic veins had been considered to be in-operable, as the tear of these veins produce uncontrollable bleeding unless total vascular occlusion is applied. In this study, the cold perfusion in-situ was performed in dogs experimentally and the results revealed the superiority of UW solution as a perfusate evaluated by Arterial Ketone Body Ratio (AKBR). In a patient with a huge tumor in the right lobe close to the IVC, we applied this method. From the left branch of the portal vein the cold lactate Ringer solution was perfused with a hole in the IVC as a outlet after the total vascular occlusion. Liver resection with a knife and reconstruction of the IVC and the hepatic veins were completed without blood loss. The recovery rate of AKBR after recirculation to the liver was prompt and enough. Using this method the resectability of the liver tumor will increase in future.