一例肝移植联合心房‑腔静脉取栓术治疗复杂性肝细胞癌的病例报告

邵瑞龙; 刘忠忠; 柳安雄; 胡志文; 叶啟发; 叶少军; 钟自彪

doi:10.14188/j.1671-8852.2025.1314

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一例肝移植联合心房‑腔静脉取栓术治疗复杂性肝细胞癌的病例报告

临床医学研究 | 更新时间：2026-11-05

- 一例肝移植联合心房‑腔静脉取栓术治疗复杂性肝细胞癌的病例报告
- A case report of liver transplantation combined with atrial‑caval thrombectomy for the treatment of complex hepatocellular carcinoma
- 武汉大学学报（医学版） 2026年47卷第10期页码：1330-1335
- 作者机构：
  
  1.武汉大学中南医院/武汉大学肝胆疾病研究院/武汉大学移植医学中心湖北武汉 430071
  2.国家人体捐献器官获取质量控制中心/移植医学技术湖北省重点实验室/湖北省天然高分子生物肝临床医学研究中心湖北武汉 430071
  3.国家卫生健康委移植医学转化研究重点实验室/中南大学湘雅三医院湖南长沙 410013
- 作者简介：
  
  邵瑞龙，男，2001—，医学硕士生，主要从事普外科研究，E‑mail：2992619217@qq.com。
  叶少军，E‑mail:86987100@qq.com
  钟自彪，E‑mail：hizzb@whu.edu.cn。
- 基金信息：
  
  国家自然科学基金委员会面上项目(82370758)
- DOI：10.14188/j.1671-8852.2025.1314
  中图分类号： R617
- 收稿：2025-11-06，
  
  纸质出版：2026-10-25
- 稿件说明：
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邵瑞龙,刘忠忠,柳安雄等.一例肝移植联合心房‑腔静脉取栓术治疗复杂性肝细胞癌的病例报告[J].武汉大学学报（医学版）,2026,47(10):1330-1335.

SHAO Ruilong,LIU Zhongzhong,LIU Anxiong,et al.A case report of liver transplantation combined with atrial‑caval thrombectomy for the treatment of complex hepatocellular carcinoma[J].Medical Journal of Wuhan University,2026,47(10):1330-1335.
邵瑞龙,刘忠忠,柳安雄等.一例肝移植联合心房‑腔静脉取栓术治疗复杂性肝细胞癌的病例报告[J].武汉大学学报（医学版）,2026,47(10):1330-1335. DOI： 10.14188/j.1671-8852.2025.1314.

SHAO Ruilong,LIU Zhongzhong,LIU Anxiong,et al.A case report of liver transplantation combined with atrial‑caval thrombectomy for the treatment of complex hepatocellular carcinoma[J].Medical Journal of Wuhan University,2026,47(10):1330-1335. DOI： 10.14188/j.1671-8852.2025.1314.

摘要

目的

介绍肝细胞癌伴下腔静脉甚至右心房癌栓形成的临床分型以及肝移植手术的可行性，为肝细胞癌晚期伴有大范围癌栓形成时的临床应用提供参考。

方法

回顾性分析1例复发性肝细胞癌伴下腔静脉及右心房癌栓形成患者的临床资料，结合文献复习，对该类晚期肿瘤的临床分型及治疗方案进行介绍总结。

结果

患者为61岁男性，既往乙肝病史31年，肝细胞癌介入治疗后8年余，肝内复发1年余，同时伴有下腔静脉癌栓形成并侵及右心房，综合评估后在体外循环下行心房‑腔静脉取栓术及经典肝移植术，术后肝功能逐渐恢复，术后28 d顺利出院，目前恢复良好。

结论

对于肝细胞癌伴下腔静脉甚至右心房癌栓形成的晚期肿瘤患者，体外循环下行肝移植手术是一种有效且可行的治疗方式，扩大了相应的手术适应证。

Abstract

Objective

To introduce the clinical classification of hepatocellular carcinoma (HCC) with inferior vena cava (IVC) tumor thrombus extending to the right atrium and to evaluate the feasibility of liver transplantation

providing a reference for the clinical management of advanced HCC with extensive tumor thrombus.

Methods

A retrospective analysis was conducted on the clinical data of a 61⁃year⁃old male patient with recurrent HCC accompanied by IVC and right atrial tumor thrombus. In combination with a literature review

we introduced and summarized the clinical classification and treatment options for this type of advanced tumor.

Results

The patient had a 31⁃year history of hepatitis B and had undergone interventional therapy for HCC 8 years previously. Liver tumor recurrence had been present for over a year and was accompanied by IVC tumor thrombus invading the right atrium. After comprehensive assessment

the patient underwent combined right atrial and IVC thrombectomy and orthotopic liver transplantation under cardiopulmonary bypass. Postoperatively

liver function gradually recovered

and the patient was discharged 28 days after the operation. Currently

the patient remains in good condition.

Conclusion

For advanced HCC patients with IVC tumor thrombus extending to the right atrium

liver transplantation under cardiopulmonary bypass is an effective and feasible treatment option

expanding the surgical indications for liver transplantation in advanced HCC.

关键词

Keywords

references

KOTSARI M , DIMOPOULOU V , KOSKINAS J , et al . Immune system and hepatocellular carcinoma (HCC): New insights into HCC progression [J ] . Int J Mol Sci , 2023 , 24 ( 14 ): 11471 .

YOON S M , RYOO B Y , LEE S J , et al . Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: A randomized clinical trial [J ] . JAMA Oncol , 2018 , 4 ( 5 ): 661 ‑ 669 .

孙居仙 , 石洁 , 程树群 . 《肝细胞癌合并肝静脉或下腔静脉癌栓多学科诊治中国专家共识(2019版)》解读 [J ] . 中国实用外科杂志 , 2021 , 41 ( 7 ): 765 ‑ 767 .

SUN J X , SHI J , CHENG S Q . Interpretation of China expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma complicated with hepatic vein or inferior vena cava tumor thrombosis (2019 edition) [J ] . Chinese Journal of Practical Surgery , 2021 , 41 ( 7 ): 765 ‑ 767 .

SHUKLA A , JAIN A . Hepatocellular carcinoma with hepatic vein and inferior vena cava invasion [J ] . J Clin Exp Hepatol , 2023 , 13 ( 5 ): 813 ‑ 819 .

中国医师协会肝癌专业委员会 . 肝细胞癌合并肝静脉/下腔静脉癌栓多学科诊治中国专家共识(2019版) [J ] . 中华医学杂志 , 2020 , 100 ( 20 ): 1532 ‑ 1538 .

Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with hepatic vein/inferior vena cava tumor thrombus (2019 Edition) [J ] . Natl Med J China , 2020 , 100 ( 20 ): 1532 ‑ 1538 .

YANG J , SHUI Y J , LIU L H , et al . Insights into treatment for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium [J ] . Hepatobiliary Surg Nutr , 2024 , 13 ( 1 ): 168 ‑ 171 .

HUANG C , LI Y Q , ZHANG F M , et al . Advancements in elucidating the mechanisms of Sorafenib resistance in hepatocellular carcinoma [J ] . Int J Surg , 2025 , 111 ( 4 ): 2990 ‑ 3005 .

LI Q , HAN J J , YANG Y L , et al . PD‑1/PD‑L1 checkpoint inhibitors in advanced hepatocellular carcinoma immunotherapy [J ] . Front Immunol , 2022 , 13 : 1070961 .

MOSENTHAL M , ADAMS W , COTLER S , et al . Locoregional therapies for hepatocellular carcinoma prior to liver transplant: Comparative pathologic necrosis, radiologic response, and recurrence [J ] . J Vasc Interv Radiol , 2024 , 35 ( 4 ): 506 ‑ 514 .

CHEN C P . Role of external beam radiotherapy in hepatocellular carcinoma [J ] . Clin Liver Dis , 2020 , 24 ( 4 ): 701 ‑ 717 .

CHO Y , CHOI J W , KWON H , et al . Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus‑based practical recommendations of the Korean liver cancer association [J ] . Clin Mol Hepatol , 2023 , 29 ( 3 ): 521 ‑ 541 .

MATSUKUMA S , EGUCHI H , WADA H , et al . Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium [J ] . BJS Open , 2020 , 4 ( 2 ): 241 ‑ 251 .

GAO J Q , ZHENG J H , ZHU Z Y , et al . Laparoscopic orthotopic right hemihepatectomy by anterior approach combined with inferior vena cava thrombectomy [J ] . Ann Surg Oncol , 2022 , 29 ( 9 ): 5548 ‑ 5549 .

FUSTER‑ANGLADA C , MAURO E , FERRER‑FÀBREGA J , et al . Histological predictors of aggressive recurrence of hepatocellular carcinoma after liver resection [J ] . J Hepatol , 2024 , 81 ( 6 ): 995 ‑ 1004 .

RAWASHDEH B , BELL R , HAKEEM A , et al . Liver transplantation as an alternative for the treatment of non‑resectable liver colorectal cancer: Advancing the therapeutic algorithm [J ] . Hepatobiliary Pancreat Dis Int , 2024 , 23 ( 2 ): 154 ‑ 159 .

LINGIAH V A , NIAZI M , OLIVO R , et al . Liver transplantation beyond Milan criteria [J ] . J Clin Transl Hepatol , 2020 , 8 ( 1 ): 69 ‑ 75 .

VERNA E C , PATEL Y A , AGGARWAL A , et al . Liver transplantation for hepatocellular carcinoma: Management after the transplant [J ] . Am J Transplant , 2020 , 20 ( 2 ): 333 ‑ 347 .

MASPERO M , SPOSITO C , WEHRLE C , et al . Post‑recurrence survival after liver transplantation for hepatocellular carcinoma [J ] . Transplantation , 2025 , 109 ( 12 ): 1862 ‑ 1870 .

DE MORAIS B G , HORBE A F , CORAL G P , et al . Results of hepatocellular carcinoma downstaging through hepatic transarterial chemoembolization in liver transplantation [J ] . Eur J Gastroenterol Hepatol , 2025 , 37 ( 1 ): 77 ‑ 82 .

MAGYAR C T J , O'KANE G M , ACEITUNO L , et al . Liver transplantation for hepatocellular carcinoma: An expanding cornerstone of care in the era of immunotherapy [J ] . J Clin Oncol , 2025 , 43 ( 5 ): 589 ‑ 604 .

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