离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式.ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除.近几年,经过众多学者对ELRA进行大量的手术实践与研究分析后,ELRA迅速发展.在疾病的适应证中,ELRA着重于晚期肝恶性肿瘤与终末期肝泡型棘球蚴病的治疗.最新的研究中,肝脏Child-Pugh评分B级和残余肝脏体积与标准肝脏体积之比为0.35～0.40的病人也能满足ELRA的肝脏要求.另外,体内临时的门腔静脉分流技术也因其术后死亡率低于过去的体外静脉-静脉转流技术而成为术中首选.术中的血管重建,重点围绕肝后下腔静脉重建方式的选择.对于需重建肝后下腔静脉的病人,则根据病灶切除后肝后下腔静脉壁缺损的程度,采用直接缝合、使用补片、使用人工血管的方式进行重建.现结合文献,对上述领域进行综述.
Surgical advances of ex-vivo liver resection and autotransplantation
As a complex surgical procedure,ex-vivo liver resection and autotransplantation(ELRA)is indicated for complex lesions invading inferior vena cava,portal vein,liver vein and their branches.In recent years,ELRA has evolved rapidly after extensive applications and researches.Major indications are advanced liver malignancies and end-stage hepatic alveolar echinococcosis(HAE).According to a recent study,patients with liver Child-Pugh score B and ratio of residual liver volume(RLV)to standard liver volume(SLV)of 0.35-0.40 might fulfill the liver requirements of ELRA.In addition,in vivo temporary portal vena cava shunting has also become a primary choice for its lower postoperative mortality than extracorporeal venous bypassing.Intraoperative revascularization focuses upon selecting reconstruction mode of retrohepatic inferior vena cava.Based upon defect severity of posterior hepatic inferior vena cava wall after lesion resection,direct suturing,patching and artificial blood vessel may be adopted.This review summarized the latest surgical researches of ELRA to further explore its development potentials.
万方数据
维普
