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目的:探讨保留下腔静脉的离体低温肝切除治疗不可切除Ⅳ型肝门部胆管癌的效果。方法:回顾性分析2例Ⅳ型肝门部胆管癌患者临床资料,其中1例行保留下腔静脉的原位低温灌注扩大右肝切除术,另1例采用保留下腔静脉的全离体扩大右肝切除治疗。结果:原位低温灌注扩大右肝切除术历时14 h,术中输血3 000 mL,然而,患者术后第1天死于多器官功能衰竭。全离体扩大右肝切除术历时15 h,术中输血2 000 mL,热缺血时间20 min,冷缺血时间195 min,术后30 d出院,无肝衰和其他重大并发症发生,随访11个月,患者仍然存活且无血管、胆管并发症及肿瘤复发和转移。结论:在有复杂肝切除经验和活体肝移植经验的前体下,保留下腔静脉的离体低温肝切除是安全的,且可能是治疗精选的不可切除IV型肝门部胆管癌的有效选择。
Objective: To investigate the effect of ex vivo low-temperature hepatic resection of the inferior vena cava in the treatment of unresectable type Ⅳ hilar cholangiocarcinoma. Methods: The clinical data of 2 patients with type Ⅳ hilar cholangiocarcinoma were retrospectively analyzed. Among them, 1 patient underwent preservation of the inferior vena cava by local hypothermic perfusion to expand the right hepatectomy, while the other 1 patient was enucleated with allogeneic preservation of inferior vena cava Right hepatectomy treatment. Results: In situ hypothermic perfusion and extended right hepatectomy lasted 14 h and intraoperative blood transfusion was 3 000 mL. However, the patient died of multiple organ dysfunction on the first postoperative day. Completely ex vivo expanded right hepatectomy lasted 15 h, intraoperative blood transfusion 2 000 mL, warm ischemic time 20 min, cold ischemia 195 min, 30 d after discharge, no liver failure and other major complications, follow-up At 11 months, the patient survived without vascular, biliary complications and tumor recurrence and metastasis. CONCLUSIONS: Ex vivo cryogenic liver resection with preserved inferior vena cava is safe and may be effective in the treatment of selected unresectable type IV hilar cholangiocarcinoma under precursors with complex hepatectomy experience and living donor liver transplant experience select.