タイムテーブル 第 1 日目 5 月30日（水） - æ ªå¼ä¼šç¤¾ã‚³ãƒ³ã‚°ãƒ¬

MVW1-1
SurgicalresectionforHCCwithIVC
thrombosis
Department of Surgery, Ajou University School of
Medicine, Suwon, Korea
○…HEE…JUNG…WANG
Involvement… of… hepatocellular… carcinoma…(HCC)…into… the… inferior…
vena…cava…(IVC)…and…right…atrium…(RA)…has…been…considered…as…
unresectable… tumor… invasion… because… of…high… operative… risks… and…
poor… prognosis.… Recent… advance… in… operative… technique… and…
perioperative…management…could…allow…removal…of…extensive…tumor…
thrombi…in…IVC…and…/or…RA.…Although…survival…benefit…has…not…been…
guaranteed,…such…procedure…could…provide…somewhat…improvement…
of…survival…time.…We…herein…report…one…case…of…hepatic…resection…and…
tumor…thrombectomy…of…HCC…with…tumor…thrombus…extending…into…
right… atrium,… using… cardiopulmonary… bypass… and… total… vascular…
exclusion.…A…47-year-old…man…had…huge…HCC…in…left…lobe…of…the…liver,…
and… tumor… thrombus… extending… into… IVC… and… RA.… Left…
hemihepatectomy… was… performed… and… tumor… thrombus… was…
completely…removed…with…cardiopulmonary…bypass.…The…operation…
took… 560… minutes… and… the… patient… had… uneventful… postoperative…
course.…Although…the…prognosis…of…advanced…HCC…with…IVC…and…RA…
tumor…thrombi…is…poor,…surgical…resection…might…somewhat…improve…
the…survival…time…in…selective…patients.
MVW1-2
Thelivingdonorhepatectomyproceduresto
preventbiliarycomplications
Kyushu University
○…TORU…IKEGAMI,Ken……Shirabe,Tomoharu……Yoshizumi,
Toshiro…Masuda,hiroto…Kayashima,Kazutoyo…Morita,
Naotaka…Hashimoto,Takeo…Toshima,Yohei…Mano,
jun…Muto,Shohei…Yoshiya,Yoshihiko…Maehara
(Backgrounds)……Although…donor…safety…is…the…critical…issue…in…living…
donor…liver…transplantation,…biliary…complications…still…occur…with…the…
rate… around… 5%.……(Methods)……The… living… donor… hepatectomies…
performed…at…Kyushu…University…(n=414)…was…included.……Since…2005…
(n=214),… we… performed… minimal… hilar… dissection… only… at… the… 1st…
Glissonian…branch…and…real-time…cholecystcholangiography…for…the…
purpose.……(Surgical… procedures)……Cholecystectomy… is… performed…
first,…followed…by…the…insertion…of…cholangiogram…tube…located…in…the…
neck…of…the…gall…bladder.……The…left…and…right…Glissonean…branches…are…
controlled…by…blunt…dissection…of…the…hilar…hepatic…parenchyma…using…
a…scissor.……Special…care…must…be…taken…not…to…injure…minor…branches…
of…the…hilar…plate.……The…hilar…dissection…is…performed…only…at…the…level…
of… the… controlled… 1st… Glissonean… branch.……Such… meticulous…
procedures,… not… to… dissect… the… peribiliary… arterial… plexus,… are…
important.……The…common…bile…duct…should…not…be…isolated…nor…taped.…
After… the… mobilization… of… the… liver,… parenchymal… division… is…
performed… using… CUSA… and… TissueLink… under… the… hanging…
maneuver.……After…the…parenchymal…division,…clips…were…applied…on…
the… 1st… Glissonean… sheath… and… real-time… cholangiogram… was…
performed…for…determining…the…cutting…line.……The…hepatic…duct…is…
sharply…cut…with…a…scissor…under…the…hilar…clamping.……The…proximal…
side… of… the… bile… duct… stump… is… closed… using… 6-0… PDS… continuous…
sutures,… caring… not… to… make… biliary… stenosis.……After… the…leak…test…
using… ICG,… real-time… cholangiogram… is… performed… to… confirm… the…
patency…of…the…biliary…tract.(Results)……Fourteen…cases…had…biliary…
complications…including…bile…leak…(n=8),…stenosis…(n=5)…and…injury…
(n=1).……Although… 11… cases… were… treated… conservatively… or…
interventional… procedures,… 2… cases… underwent… re-laparotomy… for…
fixing…the…complications.……The…mean…hospital…stay…in…the…patient…with…
biliary…complications…(n=14)…was…significantly…longer…than…that…of…
those…without…(n=400,…33…days…vs.…13…days).……Since…2005,…the…biliary…
complication…rate…was…significantly…suppressed…than…before…(1.1%…vs.…
6.4 %).…(Summary)……Minimal… hilar… dissection… technique… to… keep…
biliary…vascular…plexus…and…real-time…cholecystcholangiogram…are…
the…important…techniques…to…prevent…biliary…complications…in…living…
donor…liver…hepatectomies.
MVW1-3
LivingDonorLiverTransplantationwithPortal
VeinThrombus;PortalVeinReconstruction
TechniqueusingLeftGastricVein
Kobe University
○…KAORI…KURAMITSU,Takumi…Fukumoto,Sinobu…Tuchida,
Masahiro…Kido,Masanori…Takahashi,Motofumi…Tanaka,
Kenji…Fukusima,Takeshi…Urade,Tetsuo…Ajiki,
Ippei…Matusmoto,Kimihiko…Ueno,Makoto…Sinzeki,
Hirotika…Toyama,Yonson…Ku
For… the… reconstruction… of… portal… vein… with… portal… vein… thrombus…
(PVT)… in… living… donor… liver… transplantation…(LDLT),… several…
techniques,…such…as…thrombectomy,…anastomosis…with…recipient…distal…
superior… mesenteric… vein…(SMV)… and… donor… PV… using… an…
interposition…iliac…vein…graft…from…the…donor,…or…direct…anastomisis…to…
an…available…branch,…have…been…employed…based…on…the…extent…of…
thrombosis… accessed… intraoperatively.…We… have… experienced… two…
cases… of… PV… reconstruction… to… the… left… gastric… vein… using… an…
interposition…iliac…vein…graft…from…the…recipients.…Case1;…A…55-year…
old…female…was…performed…LDLT…for…liver…cirrhosis…with…HCV…using…
right…lobe…graft…from…her…son.…The…top…level…of…PVT…reached…inside…
the… original… liver,… and… bottom… level… reached… to… the… confluence… of…
SMV…and…splenic…vein.…First…we…tried…to…perform…thrombectomy;…
however…organized…thrombus…was…reached…to…the…further…level…from…
superior…border…of…pancreas,…we…searched…for…another…anastomosis…
site.… As… left… gastric… vein… was… dilated… due… to… severe… portal…
hypertension…and…vessel…wall…was…thick…enough…for…anastomosis,…we…
reconstructed…donor…PV…with…left…gastric…vein…using…an…interposition…
iliac…vein…graft…from…the…recipient…after…the…confirmation…of…sufficient…
front…flow.…Operation…time…was…14…hours…and…47…minutes,…and…blood…
loss… was… 4610ml.… Post-operative… course… was… uneventful… with… no…
complications… for… two… years.… Case… 2;… A… 55-year… old… male… was…
performed…LDLT…for…liver…cirrhosis…with…NASH…using…left…lobe…graft…
from…his…son.…Preoperative…study…revealed…extensive…thrombosis…to…
SMV,…PV…trunk,…and…splenic…vein.…Although…we…first…tried…to…perform…
thrombectomy,…as…extended…thrombus…reached…to…the…further…level…
below…inferior…border…of…pancreas,…we…reconstructed…donor…PV…with…
left… gastric… vein… using… an… interposition… iliac… vein… graft… from… the…
recipient.…Operation…time…was…16…hours…and…55…minutes,…and…blood…
loss…was…5050ml.…From…our…experience,…it…was…suggested…that…for…
liver…transplantation…with…extensive…PVT,…left…gastric…vein…could…be…
utilized…for…reconstruction…site…of…PV.…However…for…LDLT…cases,…as…
we… need… to… secure… vessel… graft… form… the… recipient,… which… is… not…
necessary…for…deceased…donor…cases,…surgical…procedure…should…be…
discussed…in…detail…before…deciding…the…indication…of…transplantation.
MVW1-4
A simplenoninvasiveapproachtotheintrathoracicinferiorvenacavathroughthe
abdominalcavitybycuttingthediaphragm
verticallyfortotalhepaticvascularexclusion
Mie University
○…SHUGO…MIZUNO,Shuji…Isaji,Naohisa…Kuriyama,
Yoshinori…Azumi,Ichiro…Ohsawa,Masashi…Kishiwada,
Takashi…Hamada,Masanobu…Usui,Hiroyuki…Sakurai,
Masami…Tabata
Backgroud:… For… resection… of… advanced… liver… tumors… with… tumor…
thrombus/invasion…extending…into…the…intra-thoracic…inferior…vena…
cava…(IVC)…above…the…diaphragm,…isolation…of…the…intra-thoracic…IVC…
through… sternotomy… or… thoracotomy… is… usually… required… for… the…
preparation… of… total… hepatic… vascular… exclusion…(THVE).… We…
previously…reported…that…the…intra-thoracic…IVC…could…be…exposed…
easily…after…detachment…of…the…line…of…the…fusion…of…pericaridium…to…
diaphragm…(LFPD)…(Mizuno…et…al.…JHBPS…2010).…We…herein…present…
this… novel… surgical… method,… an… approach… to… intra-thoracic… IVC…
through… the… abdominal… cavity.… Method:… The… liver… is… totally…
mobilized…and…a…xiphoid…process…is…removed.…The…LFPD…is…bluntly…
dissected… usually… by… using… fingers,… and… the… pericardium… and…
diaphragm…are……separated…without…injury…of…the…pericardium.……From…
just… below… the… xiphoid… process… to… the… IVC,… the… diaphragm… is…
vertically… dissected… without… doing… median… sternotomy.… Then… the…
intra-thoracic…IVC…is…exposed…easily…and…encircled…with…an…umbilical…
tape…to…prepare…for…THVE…and…to…prevent…any…emboli…forming…from…
the… tumor… thrombi.… After… transection… of… the… liver… parenchyma,…
THVE…is…achieved…and…then…the…intracaval…tumor…thrombus…and…the…
liver… parenchyma… are… removed… en… bloc.……This… procedure… can… be…
performed… without… the… need… for… sternotomy,… thoracotomy,… and…
cutting… the… pericardium.Results:… This… technique… was… applied… in…
three… patients…(HCC:… n=2,… cholangiocellular… carcinoma:… n=1).…
Patients…age… was… 66,… 81,… and… 68… year… old,… respectively…and… all… of…
them…were…male.…The…operation…time…was…409,…572,…and…392…minutes,…
respectively.…The…postoperative…courses…of…them…were…uneventful.
Conclusion:…This…novel…approach…to…intra-thoracic…IVC…through…the…
abdominal… cavity… is… very… beneficial… and… helpful… for… many… liver…
surgeons.…
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