Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment ...Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.展开更多
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...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。展开更多
目的分析离体肝切除联合自体肝移植(ELRA)的临床疗效及安全性。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方等数据库1990年1月1日至2021年12月30日ELRA的相关研究。使用R(V4.1.2)等统计软件马尔可夫链...目的分析离体肝切除联合自体肝移植(ELRA)的临床疗效及安全性。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方等数据库1990年1月1日至2021年12月30日ELRA的相关研究。使用R(V4.1.2)等统计软件马尔可夫链-蒙特卡罗法模拟后验分布进行贝叶斯单臂荟萃分析,分析术后30 d内死亡率、术后1年生存率、术后主要并发症发生率、R0切除率等相关指标。结果最终纳入20篇文献436例患者。贝叶斯单臂荟萃分析显示:ELRA术后1年生存率为83.24%[95%最大后验概率(HPD):72.40%~92.05%],其中肝多房棘球蚴病和肝恶性肿瘤患者术后1年生存率分别为88.66%(95%HPD:81.52%~94.50%)和61.29%(95%HPD:38.53%~93.68%)。ELRA术后30 d内死亡率、术后主要并发症发生率、R0切除率分别为6.96%(95%HPD:4.47%~10.15%)、27.91%(95%HPD:19.00%~38.30%)、99.84%(95%HPD:37.61%~100.00%)。在ELRA术后30 d内死亡原因中,肾功能衰竭是最多的死亡原因。结论ELRA适用于能够通过切除获益而又无法在体内完成肝切除的肝恶性肿瘤以及肝多房棘球蚴病,安全可行,肝多房棘球蚴病获益最大,而肝恶性肿瘤仅部分患者获益。ELRA应用于肝恶性肿瘤治疗,尚需从获益角度对其适应证进行探究。展开更多
Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. H...Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure. Methods We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments （II and III） of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases （such as to the lung or brain） could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage （PTCD） was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 umol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the-left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems. Results During a 60-day following-up after operation, the patient had a good r展开更多
基金supported by agrant from the National Natural Science Foundation of China(30830099)
文摘Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.
文摘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。
文摘Background For patients with end-stage hepatic alveolar echinococcosis （AE）, in vivo resection of the involved parts of the liver is usually very difficult, therefore, allogenic liver transplantation is indicated. However, we hypothesize that for selected patents, ex vivo liver resection for thorough elimination of the involved tissues and liver autotransplantation may offer a chance for clinical cure. Methods We presented a 24-year-old women with a giant hepatic AE lesion who was treated with hepatectomy, ex vivo resection of the involved tissue and hepatic autotransplantation. The patient had moderate jaundice and advanced hepatic AE lesion which involved segments I, IV, V, VI, VII, VIII and retrohepatic inferior vena cava. The lateral segments （II and III） of the left liver remained normal with over 1000 ml in its volume. No extrahepatic metastases （such as to the lung or brain） could be found. As the first step of treatment, X-ray guided percutaneous transhepatic cholangiodrainage （PTCD） was performed twice for bile drainage in segment III and II separately until her serum total bilirubin decreased gradually from 236 to 88 umol/L. Total liver resection was then performed, followed by extended right hepatic trisegmentectomy and the entire retrohepatic vena cava was surgically removed en bloc while her hemodynamics parameters were stable. Neither veino-veinous bypass nor temporary intracorporeal cavo-caval or porto-caval shunt was used during the 5.7-hour anhepatic phase. The remained AE-free lateral segments of the-left liver were re-implanted in situ. The left hepatic vein was directly anastomosed end-to-end to the suprahepatic inferior vena cava due to the lack of the retrohepatic inferior vena cava with AE total infiltration. Because compensatory retroperitoneal porto-caval collateral circulation developed, we enclosed remained infrahepatic inferior vena cava at renal vein level without any haemodynamics problems. Results During a 60-day following-up after operation, the patient had a good r
