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

位于IVC或主肝静脉附近的肝肿瘤被认为是不可手术的，因为这些静脉的撕裂会产生无法控制的出血，除非应用完全血管闭塞。在本研究中，在实验上对犬进行了原位冷灌注，结果显示UW溶液作为灌注液的优越性，通过动脉酮体比（AKBR）评价。在一个病人的巨大肿瘤在右叶接近下腔静脉，我们采用了这种方法。门静脉左分支灌注冷乳酸林格氏液，在下腔静脉开孔作为血管完全闭塞后的出口。用刀进行肝切除并重建IVC和肝静脉，无失血。AKBR再循环至肝脏后的回收率迅速且足够。采用这种方法，肝肿瘤的可切除性将在未来增加。

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.