联合肝脏离断和门静脉切断二步肝切除术在肝炎后肝硬化肝癌中的应用  

Associating liver partition and portal vein ligation for staged hepatectomy procedure in treatment of hepatocellular carcinoma with post-hepatitic cirrhosis

作　　者：王志明[1] 陶一明[1] 黄云[1] 谭辉[1] 李劲东[1] 周乐杜[1] 李新营[1] 胡宽[1] 

机构地区：[1]中南大学湘雅医院普通外科,湖南长沙410008

出　　处：《中国普通外科杂志》2014年第7期867-872,共6页China Journal of General Surgery

基　　金：国家自然科学基金面上项目(81372630;81372631)

摘　　要：目的:探讨联合肝脏离断和门静脉切断二步肝切除术(ALPPS)在肝炎后肝硬化肝癌患者治疗中应用价值。方法:回顾性分析2014年3月中南大学湘雅医院收治的1例乙型病毒肝炎(HBV)相关性肝癌患者行ALPPS的临床资料。结果:患者术前评估未来剩余肝脏体积约占标准肝体积的20.2%。患者一期行右侧门静脉离断和左、右半肝原位劈离;患者一期手术后9 d,剩余肝脏体积达标准肝体积的38.8%后,二期行右半肝含肿瘤切除。两次手术时间分别为255 min和297 min,出血量分别为260 mL和350 mL。术后肝功能持续平稳。术后21 d出院。术后2个月随访,未见复发转移,HBV-DNA定量和AFP均在正常范围之内。结论:对于HBV非活动期合并肝硬化的肝癌可适度扩大ALPPS手术指征,手术仍然安全可行。Objective： To investigate the application value of associating liver partition and portal vein ligation in staged hepatectomy （ALPPS） for hepatocellular carcinoma （HCC） with post-hepatitic cirrhosis. Methods： The clinical data of one patient with HCC associated with hepatitis B virus （HBV） cirrhosis admitted in March 2014 to Xiangya Hospital of Central South University and undergoing ALPPS were retrospectively analyzed.Results： Preoperative assessment showed that the patient’s future liver remnant （FLR） to standard liver volume ratio was 20.2%. The patient underwent first-stage operation of right portal vein ligation and in situ splitting of the liver parenchyma, and then underwent a second-stage operation of right hemihepatectomy for tumor resection, on postoperative day （POD） 9, when the patient’s FLR to standard liver volume ratio reached 38.8% after the first-stage operation. For the first- and second-stage operation, the operative time was 255 min and 297 min, and the blood loss was 260 mL and 350 mL, respectively. The patient was discharged from the hospital on POD 21; no metastasis or recurrence occurred, and his HBV-DNA and AFP levels were within normal range during the 2-month follow-up period. Conclusion： For HCC patients with non-active HBV cirrhosis, a proper expansion of the indications for the ALPPS procedure is safe and feasible.

关 键 词：肝肿瘤 肝切除术 肝硬化 未来剩余肝脏体积 

分 类 号：R735.7[医药卫生—肿瘤]