ALPPS在肝内胆管细胞癌中的应用(附1例报告)  

Associating liver partition and portal vein ligation for staged hepatectomy for intrahepatic cholangiocarcinoma:A report of 1 case

作　　者：徐力善[1] 翟博[1] 方泰石[1] 金鑫[1] 谷越[1] 冯伟[1] 

机构地区：[1]哈尔滨医科大学附属第四医院肝胆外科,黑龙江哈尔滨150001

出　　处：《中国现代普通外科进展》2015年第4期265-272,共8页Chinese Journal of Current Advances in General Surgery

基　　金：国家自然科学基金青年科学基金项目(81401975);黑龙江省自然科学基金面上项目(D201250);黑龙江省青年科学基金项目(QC2013C103);黑龙江省教育厅科学技术研究项目(12541329)

摘　　要：目的：探讨联合肝脏离断和门静脉结扎二步肝切除术（ALPPS）治疗肝内胆管细胞癌的安全性与有效性.方法：对201 4年4月1 6日哈尔滨医科大学附属第四医院肝胆外科收治的1例累及右三叶的肝内胆管细胞癌患者施行ALPPS治疗,并对围手术期指标及随访资料进行分析.第一阶段离断肝周韧带,裸化肝十二指肠韧带,结扎门静脉右支及肝短血管,标记肝右静脉后离断左外叶与左内叶间肝组织.术后第8日,切除右三叶.结果：术前残肝体积（左外叶）为769.28 mL,占标准肝脏体积的26.5％;第一阶段术后6d残肝明显增大达1157.84mL,占标准肝脏体积的37.1％,增加50％.第一阶段手术历时300 min,出血200 mL;第二阶段手术历时150 min,出血600 mL.第一阶段手术后出现胆漏,辅助肝（右半及第Ⅳ段肝脏）每日引出250～700 mL胆汁.第二阶段手术后恢复顺利.结论：ALPPS为剩余肝脏体积不足的肝内胆管细胞癌提供了新的治疗选择.Objective：To discuss the safety and effectiveness of associating liver partition and portal vein ligation for staged hepatectomy（ALPPS） for intrahepatic cholangiocarcinoma.Methods：ALPPS was performed for 1case of intrahepatic cholangiocarcinoma on right liver on April 16,2014 in Department of Hepatobiliaric Surgery,The Fourth Hospital of Harbin Medical University.Data of perioperative period were recorded and analyzed.The first operation was to mobilize the perform right hemiliver by sectioning ligament,then a complete lymphadenectomy of hepatoduodenal ligament,portal vein ligation,splitting between S Ⅱ,S Ⅲ and SⅣ,then to isolate right and middle hepatic veins.After 8 days,the extended right lobe was removed.Results：The remnant liver volume was 769.28 mL before the first step of operation,which was increased by 50％ to 1157.84 mL before the second step of operation.The standard remnant volume accounted for 26.5％ and 37.1％ of standard whole liver volume before the first and second step of operation,respectively.The operative time for the first step and second step of operation was 300 min and 150 min.The intraoperative bleeding was 200 mL and 600mL,respectively.Complication of bile leakage occurred in auxiliary liver with 250-700 mL/d drainage.No complication occurred after the second step of operation.Conclusion：The ALPPS provides a new strategy for the cases of intrahepatic cholangiocarcinoma who could not tolerate the radical resection due to the insufficient remnant liver volume.

关 键 词：肝内胆管细胞癌 二步肝切除术 剩余肝脏体积 门静脉结扎 

分 类 号：R735.7[医药卫生—肿瘤]