全腹腔镜前入路经肝后隧道绕肝带结扎并门静脉结扎的分期肝切除术治疗肝硬变肝癌  

Totally Laparoscopic Associating Liver Tourniquet and Portal Ligation for Staged Hepatectomy Using The Anterior Approach Techniquefor Hepatocellular Carcinoma with Hepatitis B Cirrhosis

作　　者：张宇[1] 陈云飞[1] 路涛[1] 朱世凯[1] 徐均[1] 杨洪吉[1] 

机构地区：[1]四川省医学科学院(四川省人民医院)肝胆外科.器官移植中心,四川成都610072

出　　处：《中国普外基础与临床杂志》2015年第1期70-75,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生厅科研课题(项目编号:130134);四川省医学科学院(四川省人民医院)博士基金~~

摘　　要：目的探讨全腹腔镜下前入路经肝后隧道绕肝带结扎和门静脉结扎分期肝切除术(ALTPS)在乙肝肝硬变肝癌患者治疗中的应用价值。方法 2014年9月,笔者所在医院收治1例合并肝硬变的右肝原发性肝癌患者,采用全腹腔镜前入路ALTPS方案:一期手术行腹腔镜下门静脉右支结扎,前入路肝后间隙放置绕肝带结扎肝正中裂,不离断肝实质;一期手术10 d后再行全腹腔镜下右半肝切除术。结果术前评估行右半肝切除术后剩余肝脏体积(FLR)为301.48 m L,占标准肝脏体积的29.1%,占体质量的0.49%。一期手术后4 d,FLR为496.45 m L,占标准肝体积的47.9%,占体质量的0.81%,FLR较术前增加64.67%;术后第8天FLR为510.96 m L,占标准肝脏体积的49.3%,占体质量的0.84%,FLR较术前增加69.48%。术后第10天,二期行全腹腔镜右半肝切除术,二期手术后5 d,测残肝体积为704.53 m L。两次手术时间分别为180 min和220 min,出血量分别为50 m L和400 m L。术后恢复良好,术后7 d出院。结论作为联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)的一种更简便、安全、微创及更符合肿瘤学原则的改良,前入路全腹腔镜下ALTPS也能使残肝在短期内快速增生,并且对合并肝硬变的肝癌手术仍然安全可行。Objective To investigate the application value of totally laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy （ALTPS） using the anterior approach technique for hepatocellular carcinoma （HCC） with hepatitis B cirrhosis. Methods In September, 2014, a patient suffered cirrhotic hepatocellular carcinoma in the right liver scheduled for two-stage liver resection, in whom the future liver remnant （FLR） was considered too small （FLR/ standard liver volume： 29.1%, FLR/body wight： 0.49%）. In the first stage, using totally laparoscopic technique, a tourniquet was placed around the parenchymal transection line on the Cantlie＇s line via an anterior approach through retrohepatic tunnel for staged right hepatectomy, and the right portal vein was ligated. In the second stage, totally laparoscopic right hemihepatectomy was carried out on 10 days after the first-stage operation that achieved sufficient hypertrophy of the FLR. Results The FLR on postoperative day 4 of the first stage increased from 301.48 to 496.45 mL （FLR/standard liver volume： 47.9%, FLR/body wight： 0.81%）, with a 64.67% hypertrophy. And the FLR on postoperative day 8 of the first stage increased to 510.96 mL （FLR/standard liver volume： 49.3%, FLR/body wight： 0.84%）, with a 69.48% hypertrophy. The remnant liver volume on postoperative day 5 of the second stage increased to 704.53 mL. The duration of the first stage was 180 min, intraoperative blood loss was 50 mL, and patient did not received a blood transfusion. The duration of the second stage was 220 min, intraoperative blood loss was 400 mL, and patient did not required a blood transfusion. No serious complications happened. The patient was discharged on 7 days after the second stage. Conclusions As a effective, safe, simple, and ＂non-touch＂ technique which provided a less aggressive modification of the ALPPS procedureto achieve oncological efficacy, the totally laparoscopic ALTPS using the anterior approach technique also could achie

关 键 词：肝肿瘤 肝硬变 腹腔镜 联合肝脏结扎和门静脉结扎的二步肝切除术 前入路技术 

分 类 号：R735.7[医药卫生—肿瘤]