Minimally invasive surgical treatment of primary liver cancer with portal hypertension

doi:10.3877/cma.j.issn.1674-6899.2024.05.010

Abstract

Abstract:

Objective

To review and summarize the laparoscopic surgical treatment for patients with primary liver cancer complicated by portal hypertension at our center， and to discuss the surgical treatment principles for these patients.

Methods

A patient with hepatitis B-related liver cirrhosis， recurrent upper gastrointestinal bleeding， and recent clinical diagnosis of primary liver cancer with portal vein hypertension，admitted to the Department of Hepatobiliary and Liver Transplant Surgery at Nanjing Drum tower Hospital in May 2024， was evaluated through liver function and reserve assessment， gastrointestinal endoscopy， and tumor staging. Based on these evaluations， a surgical treatment plan was formulated.

Results

The patient successfully underwent laparoscopic liver resection combined with total splenectomy and laparoscopic periscardia vascular disconnection. The procedure had minimal blood loss， and there were no postoperative complications such as infection， bleeding， bile leakage， or portal vein thrombosis. Recovery was smooth，and postoperative pathological examination confirmed combined hepatocellular carcinoma and cholangiocarcinoma.

Conclusion For patients with primary liver cancer complicated by portal hypertension，a comprehensive preoperative assessment allows for surgical treatment of both the tumor and complications of portal hypertension could benefit the patient.

Key words: Liver cancer, Portal hypertension, Laparoscopic hepatosplenectomy, Laparoscopic periscardia vascular disconnection

Fei Wang, Zheng Chen, Decai Yu, Yajuan Cao. Minimally invasive surgical treatment of primary liver cancer with portal hypertension[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(05): 306-310.

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References 16

1	王卫东.肝癌合并门静脉高压症的诊治现状［J］.世界华人消化杂志， 2018， 26（24）：1429-1433.
2	中华医学会外科学分会脾及门静脉高压外科学组. 门静脉高压合并肝细胞癌临床诊断与治疗中国专家共识（2022 版）［J］. 中华消化外科杂志， 2022， 21（4）：444-455.
3	任家俊，陈拥军. 肝脾联合切除治疗原发性肝癌合并门静脉高压及脾功能亢进［J］. 外科理论与实践， 2022， 27（2）：139-144.
4	European Association for the Study of the Liver. EASL clinical practice guidelines： management of hepatocellular carcinoma［J］. J Hepatol， 2018， 69（1）：182-236.
5	Heimbach JK， Kulik LM， Finn RS， et al. AASLD guidelines for the treatment of hepatocellular carcinoma［J］. Hepatology， 2018，67（1）：358-380.
6	陈孝平，吴在德，裘法祖. 肝癌切除联合脾切除治疗肝癌合并肝硬化、脾功能亢进［J］. 华中科技大学学报（医学版）， 2005，（3）：261.
7	原发性肝癌外科治疗方法的选择［J］. 中华肝脏病杂志， 2005，13（5）：329-330.
8	李宇. 腹腔镜脾切选择性贲门周围血管离断联合肝切除治疗门脉高压合并肝细胞癌的临床研究［D］. 广东：南方医科大学，2023.
9	单成祥，杨宁，杨广顺. 同期联合手术治疗原发性肝癌伴严重门静脉高压症疗效评价［J］. 中国实用外科杂志， 2009， 29（5）：409-412.
10	Ramai D， Ofosu A， Lai JK， et al. Combined hepatocellular cholangiocarcinoma： a population-based retrospective study［J］. Am J Gastroenterol， 2019， 114（9）：1496-1501.
11	Nagtegaal ID， Odze RD， Klimstra D， et al. The 2019 WHO classification of tumours of the digestive system［J］. Histopathology，2020， 76（2）：182-188.
12	Zhang YZ， Liu YC， Su T， et al. Current advances and future directions in combined hepatocellular and cholangiocarcinoma［J］.Gastroenterol Rep （Oxf）， 2024， 12：goae031.
13	Zhang HC， Zhu T， Hu RF， et al. Contrast-enhanced ultrasound imaging features and cl inical characteristics of combined hepatocellular cholangiocarcinoma：comparison with hepatocellular carcinoma and cholangiocarcinoma［J］. Ultrasonography， 2020， 39（4）：356-366.
14	Song DJ， Zhu K， Tan JP， et al. Perioperative and oncologic outcomes of laparoscopic versus open liver resection for combined hepatocellular-cholangiocarcinoma： a propensity score matching analysis［J］. Surg Endosc， 2023， 37（2）：967-976.
15	Vilchez V， Shah MB， Daily MF， et al. Long-term outcome of patients undergoing liver transplantation for mixed hepatocellular carcinoma and cholangiocarcinoma： an analysis of the UNOS database［J］. HPB （Oxford）， 2016， 18（1）：29-34.
16	Beaufrère A， Calderaro J， Paradis V. Combined hepatocellularcholangiocarcinoma： an update［J］. J Hepatol， 2021， 74（5）：1212-1224.

项目	第1天	第2天	第5天	第8天	第10天	第65天
白细胞（×10⁹）	8.7	13.7	6.4	7.0	6.4	6.6
血红蛋白（g/L）	82	91	87	89	91	99
血小板（×10⁹）	93	135	231	416	436	299
谷丙转氨酶（U/L）	176.2	-	92.8	34.2	38	47.4
谷草转氨酶（U/L）	254.4	-	34.6	23.1	41	51.8
总胆红素（μmol/L）	20.4	-	18.5	9.5	10.4	12.5

项目	第1天	第2天	第5天	第8天	第10天	第65天
白细胞（×10⁹）	8.7	13.7	6.4	7.0	6.4	6.6
血红蛋白（g/L）	82	91	87	89	91	99
血小板（×10⁹）	93	135	231	416	436	299
谷丙转氨酶（U/L）	176.2	-	92.8	34.2	38	47.4
谷草转氨酶（U/L）	254.4	-	34.6	23.1	41	51.8
总胆红素（μmol/L）	20.4	-	18.5	9.5	10.4	12.5

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[2]	Mei Tang, Li Zhou, Cenyue Niu, Xiaotong Zhou, Qian Wang. Clinical significance of ICG fluorescence guided laparoscopic hepatectomy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 655-658.
[3]	Fanli Zeng, Zhikai Qi, Heqing Yang. Comparison of oncologic efficacy and risk of two kinds of hepatectomy via Glisson pedicle sheath anatomical route for primary liver cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 525-527.
[4]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
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[9]	Yuhan Yuan, Shengli Yang. Research progress in proteomic analysis of body fluids and tissues in early molecular diagnosis of liver cancer [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 883-888.
[10]	Yanping Liang, Yanrou Chen, Yunxiao Liang, Feihu Bai, Bin Wu, Xing Wang. Investigation report on endoscopic management of esophagogastric variceal bleeding in portal hypertension in Southern China [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 390-395.
[11]	Zexue Qi, Lianhui Zhao, Guangchuan Wang, Chunqing Zhang. Discuss of the progress of clinical application of transjugular intrahepatic portal shunt from domestic expert consensus recommendation [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(03): 193-196.
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[13]	Qiaoling Wei, Yan Huang, Chang Zhao, Qingfeng Song, Zuyi Chen, Ying Huang, Chang Meng, Jing Huang. Construction and verification of moderate to severe pain risk prediction model after microwave ablation of liver cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(08): 715-721.
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[15]	Ying Li, Yan Liang, Ruixian He. Application and exploration of KTH integrated intervention model in nursing care of hepatic artery infusion chemotherapy for liver cancer [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(01): 82-85.

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