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中国癌症防治杂志 ›› 2015, Vol. 7 ›› Issue (4): 264-268.doi: 10.3969/j.issn.1674-5671.2015.02.06

• 临床研究 • 上一篇    下一篇

联合肝脏离断和门静脉结扎的二步肝切除术一例并文献复习

  

  1. 广西医科大学附属肿瘤医院肝胆外科;广西肝癌诊疗工程技术研究中心;广西医科大学研究生学院;区域性高发肿瘤早期防治研究教育部重点实验室(广西医科大学)
  • 出版日期:2015-08-25 发布日期:2015-09-08
  • 通讯作者: 黎乐群 Li_lequn @263.net
  • 基金资助:

    国家自然科学基金资助项目(81260331);国家科技重大专项课题(2012ZXl0002010001009)

Associating liver partition and portal vien ligation for staged hepatectomy:a case report and literature review

  • Online:2015-08-25 Published:2015-09-08

摘要:

 目的 讨论联合肝脏离断和门静脉结扎的二步肝切除术(associating liver partition and portal vien ligation for staged hepatectomy,ALPPS)治疗巨大肝癌的可行性、安全性和临床价值。方法 收治1例巨大肝癌患者并行ALPPS,回顾分析其临床资料并复习文献。结果 术前评估患者未来剩余肝脏体积约占标准肝体积的21.06%。患者一期手术行右侧门静脉结扎和左、右半肝原位劈离;一期手术术后7 d,剩余肝脏体积达标准肝体积的48.84%,第13天二期手术行右半肝切除术。术后患者未出现严重肝功能衰竭,但围手术期出现胸腔积液和腹水等并发症,经治疗后顺利出院。术后 2 个月随访,未见复发、转移,AFP降至正常范围。结论 ALPPS为残肝体积过小的肝肿瘤患者接受根治性切除术提供了一种新方法,但ALPPS并发症和死亡率均较高,采取该术式应慎重。

关键词: 肝肿瘤, 联合肝脏离断和门静脉结扎的二步肝切除术, 文献复习

Abstract:

Objective To investigate the safety and efficacy of associating liver partition and portal vien ligation for staged hepatectomy(ALPPS)for the treatment of huge hepatocellular carcinoma (HCC). Methods A patient with huge HCC was admitted in June 2014 to the Affiliated Tumor Hospital of Guangxi Medical University and underwent ALPPS. The clinicopathological characteristics and operative outcomes of this patient were compared with the ALPPS literature. Results Preoperative assessment showed a ratio of future liver remnant to standard liver volume of 21.06%. The patient underwent a first-stage operation involving right portal vein ligation and in situ splitting of the liver parenchyma. At 7 d after this operation, the ratio of future liver remnant to standard liver volume was 48.84%. At 13 d after the first operation, the patient underwent a second-stage operation involving right hemihepatectomy. The patient experienced perioperative pleural effusion and ascites, and was discharged without severe postoperative liver failure. During 2-month follow-up, no metastasis or recurrence occurred, and AFP levels remained within the normal range. Conclusion ALPPS may be a new treatment option for patients with liver neoplasm whose future liver remnant volume is too small to allow radical resection. ALPPS is associated with high morbidity and mortality, suggesting the need for careful patient selection.

Key words: Liver neoplasm, Associating liver partition and portal vien ligation for staged hepatectomy, Literature review