探讨自体门静脉在离体肝切除自体肝移植术中的应用价值。

回顾性分析2009年7月在第三军医大学西南医院接受诊治，行离体肝切除自体肝移植的1例胆管细胞肝癌患者临床资料。患者男，61岁。因上腹部隐痛不适、乏力、纳差1个月，皮肤、巩膜黄染半个月，大便颜色变浅6 d入院。计算机体层摄影术（CT）检查示肝左内叶、右前叶占位性病变，肝中静脉、肝左静脉及肝右静脉根部受侵。磁共振胰胆管成像（MRCP）检查示左肝管受侵，肝内胆管扩张。患者行离体肝切除自体肝移植术。患者签署知情同意书，符合医学伦理学规定。术中将肝脏移出体外，完整切除肿瘤，将肝断面的肝右静脉属支开口整形为共同开口，截取自体门静脉作为架桥静脉重建肝静脉流出道，原位移植剩余肝脏。观察患者术中及术后情况。

手术顺利，无肝期时间200 min，体外肿瘤切除及自体门静脉重建肝静脉流出道耗时130 min。术后恢复顺利，术后15 d肝功能各项指标全部恢复正常，多次行超声检查示肝静脉、门静脉、肝动脉血液流速良好。患者康复出院。术后病理检查证实为胆管细胞肝癌。

在体外肝切除自体肝移植术中，应用自体门静脉重建肝静脉流出道具有一定的优势，选择合适病例可以取得较好的临床疗效。

To explore the application of autologous portal vein graft in the in vitro hepatectomy and liver autotransplantation.

Clinical data of a patient with cholangiocarcinoma who underwent in vitro hepatectomy and liver autotransplantation in the Southwest Hospital of the Third Military Medical University on July 2009 were analyzed retrospectively. The patient was male, 61 years old and was admitted in the hospital for one month of upper abdominal pain and discomfort, hypodynamia, loss of appetite, yellow skin and sclera for half a month and 6 days of shallowing stool color. Occupying lesions in the left medial lobe and right anterior lobe, infiltrated middle, left hepatic vein and infiltrated root of the right hepatic vein were observed by computed tomography(CT). The magnetic resonance cholangiopancreatography(MRCP) showed the left hepatic duct was infiltrated and intrahepatic bile duct dialated. The informed consent of the patient was obtained and the ethical committee approval was received. The patient received in vitro hepatectomy and liver autotransplantation. The liver was removed out of the body and the tumor was resected completely. The branch of the right hepatic vein on the cut of liver underwent plasty to be a jointly entry. The liver venous outflow was rebuilt using autologous portal vein graft and the remanent liver was transplanted in situ. The intraoperative and postoperative condition of the patient were observed.

The operation was successful. The anhepatic phase was 200 min. The time spend of in vitro hepatectomy and reconstruction of venous outflow using autologous portal vein graft was 130 min The patient recovered well and the liver function indexes regained normal 15 d after the operation. The blood flow of the hepatic vein, portal vein and hepatic artery were good by repeated CT scan. The patient were discharged healthy. The postoperative pathological examination showed cholangiocarcinoma.

For the in vitro hepatectomy and liver autotransplantation, there are advantages of using the autologous portal vein graft to rebulid the liver venous outflow. To select a suitable patient can achieve good clinical efficacy.