| ObjectiveTo explore the clinical classification and reasonable surgical treatment for hepatocellular carcinoma with inferior vena cava tumor thrombus(HCIVCTT).MethodsWe retrospectively analyzed seven cases for HCIVCTT patients undergoing surgery in our hospital. Among them, there are 6 males and 1 female, aged 35 to 60 years, with an average age of 43 years. The main symptom is abdominal pain. Among them, one case suffered liver bleeding and hemorrhagic shock in emergency admission to hospital. No cases suffered the symptoms for the obstruction of the inferior vena cava,such as lower limbs edema. All patients were preoperatively diagnosed, Among them, 4 cases for CT scans and 7 cases for MRI scans, certainly, CT and MRI scans were performed in enhancement to clarify the position of HCIVCTT and the obstruction of IVC tumor thrombus. 6 cases had a single foci, 1 case had two foci. For 3 cases,the liver tumor were in the left liver, and for 4 cases the liver tumor were in the right liver. Tumor diameter were about 5.0~16.0cm. Combined with preoperative imaging and intraoperative transesophageal echocardiography for the location of thrombus, we divided HCIVCTT into three types. 2 cases belong to typeⅠ: thrombus via hepatic vein or hepatic short vein into the inferior vena cava,there upper pole locate below the level of the diaphragm and above the renal vein. We implemented Hepatectomy、subphrenic total hepatic ischemia(blocked in the upper embolus)、cutting inferior vena cava(IVC) for embolectomy; 4 cases belong to typeⅡ: thrombus extend through the inferior vena cava there upper pole locate between the right atrium entrance and the diaphragm. We implemented Hepatectomy、the diaphragm total hepatic ischemia(by the incision of the abdomen and diaphragm to expose the IVC above diaphragm to block the upper of IVC tumor thrombus)、cutting inferior vena cava(IVC) for embolectomy; 1 case belong to type Ⅲ: the upper pole of thrombus has entered the right atrium. We implemented thoracoabdominal incision、liver resection、extracorporeal circulation、cutting the right atrium and IVC for embolectomy. Where for the typeⅡ HCIVCTT, the way we revealed and blocked the IVC above diaphragm was: cutted the diaphragm in a vertical incision part above the liver in front of IVC(but did not cut the diaphragmatic vena cava hiatus), fully revealed pericardial diaphragmatic inferior vena cava, separate envelope on both sides of the inferior vena cava diaphragmatic pericardium, place a pre-blocked with there.ResultsAll cases were successfully operated,no cases of intraoperative died. Intraoperative total hepatic ischemia time was 13~33min. Pathological were all hepatocellular carcinoma. 7 cases suffered pleural effusion,Among them, 2 cases recorered by the drainage of chest tube,and the others recorered after conservative treatment. 4 cases suffered ascites, recorered by diuretic treatment. 2 cases suffered pulmonary infection, recorered by anti-infection treatment. All patients were follow-uped and the end of follow-up time was April 30, 2015. The postoperative survival time of 7 cases was 3 to 22 months,and the median survival time is about 8.75 months, and the postoperative survival time of 3 cases in death was 3,11,22 months; the survival time of 4 survival cases was 7,8,8,13 months, among them,1 case suffered postoperative intrahepatic recurrence and 2 cases suffered pulmonary metastasis.ConclusionCombined with preoperative imaging and intraoperative transesophageal echocardiography for the location of thrombus to classificate HCIVCTT, and to take different surgical methods according to this classification has some guiding values for clinical practice. |
PDF Full Text Request