PDF(Pubmed)
Abstract：
UNASSIGNED: Leiomyosarcomas (LMS) involving the inferior vena cava (IVC) is a clinically rare entity, accounting for approximately 0.5% of all adult sarcomas.
UNASSIGNED: A 67-year-old male presented to the emergency department with mild back and lower abdominal pain. During the workup, a computed tomography scan without contrast showed an area of decreased attenuation within the liver adjacent to the intrahepatic IVC. Magnetic resonance imaging confirmed the involvement of the retro-hepatic IVC; biopsy confirmed the diagnosis of LMS. Given the location of the involvement of the retro-hepatic IVC, liver explantation was deemed necessary for adequate tumor resection. The superior extension of the tumor toward the heart necessitated Cardio-Pulmonary (CPB). The patient successfully underwent a complex surgical procedure involving liver explantation with ex vivo back-table resection of the retro-hepatic LMS, replacement of the retro-hepatic vena cava with a ringed Gore-Tex graft, liver re-implantation, and hepatic vein-atrial reconstruction under cardiopulmonary bypass. There were no intraoperative or post-op complications.
UNASSIGNED: The role of vascular reconstruction of the IVC varies depending on the level and extent of the tumor, with options ranging from primary repair, ligation, or reconstruction dictated. Surgical resection with negative margins remains the treatment of choice due to the lack of efficacy of adjuvant therapies. Importantly, liver explantation offers a chance for complete surgical resection and reconstruction. Similarly, the complex nature of the tumor necessitated a pioneering approach involving direct hepato-atrial venous anastomosis.
UNASSIGNED: To the best of our knowledge, this is the first reported case in which the hepatic veins were anastomosed directly to the right atrium while also replacing the native vena cava with a separate graft.
UNASSIGNED: A 67-year-old male presented to the emergency department with mild back and lower abdominal pain. During the workup, a computed tomography scan without contrast showed an area of decreased attenuation within the liver adjacent to the intrahepatic IVC. Magnetic resonance imaging confirmed the involvement of the retro-hepatic IVC; biopsy confirmed the diagnosis of LMS. Given the location of the involvement of the retro-hepatic IVC, liver explantation was deemed necessary for adequate tumor resection. The superior extension of the tumor toward the heart necessitated Cardio-Pulmonary (CPB). The patient successfully underwent a complex surgical procedure involving liver explantation with ex vivo back-table resection of the retro-hepatic LMS, replacement of the retro-hepatic vena cava with a ringed Gore-Tex graft, liver re-implantation, and hepatic vein-atrial reconstruction under cardiopulmonary bypass. There were no intraoperative or post-op complications.
UNASSIGNED: The role of vascular reconstruction of the IVC varies depending on the level and extent of the tumor, with options ranging from primary repair, ligation, or reconstruction dictated. Surgical resection with negative margins remains the treatment of choice due to the lack of efficacy of adjuvant therapies. Importantly, liver explantation offers a chance for complete surgical resection and reconstruction. Similarly, the complex nature of the tumor necessitated a pioneering approach involving direct hepato-atrial venous anastomosis.
UNASSIGNED: To the best of our knowledge, this is the first reported case in which the hepatic veins were anastomosed directly to the right atrium while also replacing the native vena cava with a separate graft.
摘要：
未经证实：累及下腔静脉（IVC）的平滑肌肉瘤（LMS）是临床上罕见的实体，约占所有成人肉瘤的0.5％。
UNASSIGNED：一名67岁男性因轻度背部和下腹部疼痛出现在急诊科。在工作期间,无对比的计算机断层扫描显示肝内IVC附近的肝脏内衰减减少的区域。磁共振成像证实肝后IVC受累；活检证实了LMS的诊断。鉴于肝后IVC受累的位置，肝脏移植被认为是充分切除肿瘤所必需的.肿瘤向心脏的向上延伸需要心肺（CPB）。患者成功地接受了复杂的外科手术，包括肝脏移植和离体回台切除后肝LMS，用环状Gore-Tex移植物代替肝后腔静脉，肝脏再植入，体外循环下肝静脉-心房重建。没有术中或术后并发症。
UNASSIGNED：IVC血管重建的作用因肿瘤的水平和程度而异，有从初级修复的选择，结扎,或重建决定。由于缺乏辅助治疗的功效，切缘阴性的手术切除仍然是首选的治疗方法。重要的是,肝脏移植提供了一个完整的手术切除和重建的机会。同样，肿瘤的复杂性需要一种开创性的方法，包括直接肝-心房静脉吻合术。
未经授权：据我们所知，这是首例报道的病例，其中肝静脉直接吻合到右心房，同时还用单独的移植物代替了天然腔静脉。
UNASSIGNED：一名67岁男性因轻度背部和下腹部疼痛出现在急诊科。在工作期间,无对比的计算机断层扫描显示肝内IVC附近的肝脏内衰减减少的区域。磁共振成像证实肝后IVC受累；活检证实了LMS的诊断。鉴于肝后IVC受累的位置，肝脏移植被认为是充分切除肿瘤所必需的.肿瘤向心脏的向上延伸需要心肺（CPB）。患者成功地接受了复杂的外科手术，包括肝脏移植和离体回台切除后肝LMS，用环状Gore-Tex移植物代替肝后腔静脉，肝脏再植入，体外循环下肝静脉-心房重建。没有术中或术后并发症。
UNASSIGNED：IVC血管重建的作用因肿瘤的水平和程度而异，有从初级修复的选择，结扎,或重建决定。由于缺乏辅助治疗的功效，切缘阴性的手术切除仍然是首选的治疗方法。重要的是,肝脏移植提供了一个完整的手术切除和重建的机会。同样，肿瘤的复杂性需要一种开创性的方法，包括直接肝-心房静脉吻合术。
未经授权：据我们所知，这是首例报道的病例，其中肝静脉直接吻合到右心房，同时还用单独的移植物代替了天然腔静脉。
