背景:使用右胃表皮动脉(RGEA)的冠状动脉旁路移植术(CABG)是一种公认的,安全的程序。然而,在随后的腹部手术中使用RGEA移植物的问题会导致致命的并发症.本报告介绍了使用RGEA在CABG后进行右肝切除术治疗肝细胞癌的第一例。
方法:我们描述了一个病例,其中一名81岁的男性肝细胞癌患者在CABG后使用RGEA移植物安全地进行了右肝切除术。术前,构建三维计算机断层扫描(3D-CT)图像以确认RGEA移植物的运行。如果RGEA移植物有问题,则在心血管外科医生的待命下进行手术。RGEA移植物与肝镰状韧带形成粘连,需要细致的解剖。右肝切除术后,左肝叶下降到空出的空间,在RGEA上施加牵引力。然而,通过将肝镰状韧带缝合到腹壁来减轻这种牵引,确保RGEA的稳定性。术中、术后均无并发症发生。
结论:术前确认RGEA移植物的功能和解剖至关重要,术中轻轻地处理它,并与心血管外科医生合作。
BACKGROUND: Coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) is a well-established, safe procedure. However, problems with RGEA grafts in subsequent abdominal surgeries can lead to fatal complications. This report presents the first
case of right hepatectomy for hepatocellular carcinoma after CABG using the RGEA.
METHODS: We describe a
case in which a right hepatectomy for an 81-year-old male patient with hepatocellular carcinoma was safely performed after CABG using a RGEA graft. Preoperatively, three-dimensional computed tomography (3D- CT) images were constructed to confirm the run of the RGEA graft. The operation was conducted with the standby of a cardiovascular surgeon if there was a problem with the RGEA graft. The RGEA graft had formed adhesions with the hepatic falciform ligament, necessitating meticulous dissection. After the right hepatectomy, the left hepatic lobe descended into the vacated space, exerting traction on the RGEA. However, this traction was mitigated by suturing the hepatic falciform ligament to the abdominal wall, ensuring stability of the RGEA. There were no intraoperative or postoperative complications.
CONCLUSIONS: It is crucial to confirm the functionality and anatomy of the RGEA graft preoperatively, handle it gently intraoperatively, and collaborate with cardiovascular surgeons.