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目的探讨在全肝血流控制下不采用静脉转流技术行下腔静脉重建的肝叶切除治疗侵犯下腔静脉的肝癌的临床经验和疗效。方法自2004年8月至2005年7月,对3例胆管细胞性肝癌和2例肝细胞性肝癌合并下腔静脉直接侵犯而无癌栓患者,在全肝血流控制而无静脉转流技术下行解剖性肝叶切除联合下腔静脉重建术(局部切除修复2例、局部切除补片2例、人工血管移植1例)。结果5例患者手术均成功。平均手术时间345(300～450)min,平均手术失血量1375 (1200—1800)ml。累计平均肝门阻断时间、全肝血流阻断时间和下腔静脉阻断时间分别为19 min、21．2min、56 min。术后发生胸腔积液1例,胆漏1例,腹水1例,均治愈。患者平均住院时间15．5 (11—19)d。随访4～15个月,1例术后9个月死于肿瘤复发,4例已存活4、8、10、15个月。结论在全肝血流控制而无静脉转流技术下行下腔静脉重建联合解剖性肝叶切除治疗直接侵犯下腔静脉的肝癌不仅可安全施行,而且可延长患者生存时间。
Objective To investigate the clinical experience and curative effect of hepatic lobar resection of inferior vena cava in the treatment of hepatic lobar venous invasion without intravenous bypass under the control of whole liver blood flow. Methods From August 2004 to July 2005, 3 patients with cholangiocarcinoma and 2 hepatocellular carcinoma with inferior vena cava directly invading without tumor embolus were treated with whole blood flow without venous bypass Descending anatomical lobectomy combined with inferior vena cava reconstructive surgery (partial resection and repair in 2 cases, partial resection patch in 2 cases, artificial vascular graft in 1 case). Results All the 5 patients were successfully operated. The average operation time was 345 (300 ~ 450) min, the mean operative blood loss was 1375 (1200-1800) ml. The cumulative average hepatic portal vein occlusion time, total hepatic blood flow occlusion time and inferior vena cava occlusion time were 19 min, 21.2 min, 56 min, respectively. Postoperative pleural effusion in 1 case, bile leakage in 1 case, ascites in 1 case, were cured. The average length of hospital stay was 15.5 (11-19) days. After 4 to 15 months of follow-up, 1 patient died of tumor recurrence 9 months after operation and 4 patients survived 4, 8, 10 and 15 months. Conclusions Downstream vena cava reconstitution combined with anatomical lobectomy with total hepatic blood flow control without venous bypass is not only safe but also prolongs the survival time of patients with hepatocellular carcinoma that directly invades the inferior vena cava.