문맥을 이환한 간담도암수술시 정정맥우회술의 임상적용 - 정정맥우회술을 이용한 장시간의 문맥혈류차단

Background/Aims: Portal vein involvement in advanced hepatobiliary cancers has precluded their resection. Recently extensive surgery including combined portal vein resection has been reported to show a better prognosis than non-resectional surgery. However, only limited duration of portal flow occlusion is permitted to prevent splanchnic venous congestion. Authors performed veno- venous bypass to prolong portal flow occlusion when extensive surgery with combined portal vein resection was undertaken. The type of surgery in which bypass was applied, duration of portal flow occlusion, and physiologic changes occurred during bypass were evaluated in this study. Methods: Three cases of passive bypass were performed, and an Anthron tube was connected between superior mesenteric vein and femoral vein. Active bypass was performed in 2 cases with BioPump which bypassed visceral venous flow to axillary vein or femoral vein. Results: Portal flow was occluded as long as up to 6 hours in passive bypass and 8 hours 33 minutes in active type without gross bowel congestion and metabolic derangements. Conclusions: Veno-venous bypass can be applicable with safety to operative situations in which portal flow occlusion should be prolonged as the portal vein is involved in advanced hepatobiliary cancers. (Korean J Gastroenterol 1997; 30:236 - 246)