存在门静脉血栓及癌栓的肝癌患者的肝移植

目的　探讨存在门静脉血栓或癌栓的肝癌患者进行肝移植的处理要点。方法　对10例存在门静脉血栓或癌栓的肝癌患者施行原位肝移植术,术前常规准备供者的髂静脉,供肝保留较长的门静脉;术中注意取尽受者门静脉内的血栓或癌栓,门静脉壁存在水肿、增厚、变硬者,尽可能切除这段门静脉;9例行低位门静脉对端吻合,1例行门静脉下腔静脉的对端吻合;术后根据患者的凝血功能状态决定是否进行抗凝治疗。结果　1例术后第6 d发生门静脉血栓形成,溶栓术后因腹腔内出血、失血性休克死亡;另9例术后门静脉血流通畅,随访2~31个月,其中1例术后2个月死于感染,4例术后7、12、13、25个月肿瘤复发,其余4例无肿瘤复发。结论　术前存在门静脉血栓或癌栓的肝癌患者,只要处理得当,采用肝移植治疗可以取得较好结果。

Liver transplantation for hepatocellular carcinoma with thrombosis or cancer emboli in portal vein

Objective To study perioperative managements and clinical outcome of liver transplantation for hepatocellular carcinoma with thrombosis and cancer emboli in portal vein.Methods From July 2000 to December 2002, 10 cases of hepatocellular carcinoma having thrombosis or cancer emboli in portal vein before operation were subjected to orthotopic liver transplantation (OLT) in our hospital. Nine patients underwent anastomosis of low portal vein by end-to-end method after cleaning the thrombosis and emboli, and one underwent cavoportal hemitransposition.Results Nine of the 10 patients recovered without recurrence of portal thrombosis. One died of portal thrombosis recurrence on the 8th postoperative day and one died of infection on the 60th postoperative day. During the follow-up period of 3 to 31 months, hepatocellular cancer recurred in 7, 12, 13 and 25 months after operations in 4 patients. The remaining 4 patients survived without tumor recurrence.Conclusion Portal thrombosis and cancer emboli are not the absolute contraindications in liver transplantation. Appropriate managements can get satisfactory results.