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The clinical and experimental study on the operative procedure of removal of tumor thrombi in the hepatic vein and inferior vena cava in patients with hepatocellular carcinoma

肝细胞癌肝静脉及下腔静脉癌栓清除术的临床及实验研究

基本信息

批准号：
60480310
负责人：
TSUZUKI Toshiharu
金额：
$ 4.1万
依托单位：
School of Medicine, Keio University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1985
资助国家：
日本
起止时间：
1985 至 1986
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-60480310/
关键词：
Hepatocellular carcinoma Hepatic vein Inferior vena cava Tumor thrombi 肝切除

项目摘要

Hepatocellular carcinoma tends to spread through tumor thrombi in the portal vein, hepatic vein and inferior vena cava. Tumor thrombi in the portal vein can be removed without difficulty but tumor thrombi in the hepatic vein extending into the inferior vena cava can only be extracted by vascular exclusion technique which consisted of clamping of hepatic artery, portal vein, infra-and supra hepatic inferior vena cava. Two patients underwent this precedure. Right trisegmentectomy and removal of tumor thrombus in the right portal vein extending into the inferior vena cava was performed using vascular exclusion of 26 minutes duration. In another patient metastatic left suprarenal tumor with tumor thrombus extending from the left suprarenal vein into the inferior vena cava was extirpated with the use of vascular exclusion of 10 minutes duration. It was shown that vascular exclusion of more than 20 minutes duration was followed by decrease in cardiac output, fall in blood pressure with elevation of peripheral vascular resistance. This was due to bleeding which was the result of congestion of the remnant liver. To establish the simple and safe operative procedure, an experimental study was carried out. Thirty eight dogs were used to clarify the usefulness of bypass procedure which diverts blood in the portal vein or inferior vena cava or both into the superior vena cava. Twenty three dogs undergoing vascular exclusion of 45 minutes duration were attended by high operative mortality. Thus, the second series of experiment was performed in 15 dogs with the use of vascular exclusion of 30 minutes. It was shown that dogs having bypass of the portal vein or portal vein and inferior vena cava underwent less remarkable changes in circulatory dynamics than that of dogs having no bypass. This result suggests feasiblity of bypass procedure.

肝细胞癌往往通过门静脉、肝静脉和下腔静脉的肿瘤血栓扩散。门静脉内的肿瘤血栓可以很容易地清除，但肝静脉内延伸到下腔静脉的肿瘤血栓只能通过夹紧肝动脉、门静脉、肝下下腔静脉及肝上下腔静脉的血管排除技术来清除。两名患者接受了这一手术。行右三节切除及右门静脉肿瘤血栓切除，肿瘤血栓延伸至下腔静脉，血管排除时间为26分钟。另一位患者转移性左肾上肿瘤，肿瘤血栓从左肾上静脉延伸到下腔静脉，使用血管排除持续10分钟切除。结果表明，血管排除时间超过20分钟后，心排血量减少，血压下降，外周血管阻力升高。这是由于残余肝脏充血导致的出血。为了建立简单、安全的手术方法，进行了实验研究。38只狗被用来阐明旁路手术的有效性，该手术将门静脉或下腔静脉或两者的血液转移到上腔静脉。23只狗接受了45分钟的血管排除术，手术死亡率很高。因此，第二系列实验在15只狗身上进行，使用血管隔离30分钟。结果表明，行门静脉旁路术或门静脉-下腔静脉旁路术的狗的循环动力学变化不如未行旁路术的狗明显。结果提示旁路手术的可行性。