联合肝脏分隔和门静脉结扎的二步肝切除术治疗肝硬化肝癌  

Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of hepatocellular carcinoma with cirrhosis

作　　者：王广义[1] 魏锋[1] 张平[1] 孙晓东[1] 石小举[1] 蒋超[1] 吕国悦[1] 

机构地区：[1]吉林大学白求恩第一医院肝胆胰外科、吉林大学肝移植中心,长春130021

出　　处：《中华消化外科杂志》2016年第5期448-454,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81201711）;国家卫生和计划生育委员会卫生公益性行业科研专项（201302016）;吉林省科技厅重点科技攻关项目（20130206026SF）

摘　　要：目的探讨联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）治疗肝硬化肝癌的安全性和临床疗效。方法采用回顾性队列研究方法。收集2014年10月至2015年8月吉林大学白求恩第一医院收治的5例行ALPPS肝硬化原发性肝癌患者（以下简称肝硬化肝癌）的临床资料。术前根据患者肝功能和肝脏储备功能，制订手术方案。第1步手术：患者行相应门静脉结扎和肝脏分隔。第2步手术：第1步手术后10、14、18d复查CT，监测剩余肝脏体积（FLR）增长情况，当达到安全切除标准时，则行第2步手术，完整切除包含肿瘤的半肝或肝段。观察指标：（1）观察患者术中情况：肝硬化程度、第1步手术时间、第1步手术术中出血量、第1步手术后FLR、手术间隔时间、肝体积增长率、FLR与标准肝脏体积（SLV）比值，第2步手术时间和术中出血量。（2）手术前后生化指标情况：第1步和第2步手术前后TBil和ALT指标值。（3）术后情况：术后并发症发生情况、术后病理学检查结果、术后住院时间。（4）随访情况。采用电话预约、门诊方式随访。随访内容包括：影像学检查、肿瘤标志物检查、肿瘤复发转移、患者生存情况等内容，随访时间截至2015年11月。计量资料采用均数（范围）表示。结果（1）患者术中情况：5例患者肝硬化程度分级为F3级1例，F4级4例。5例患者中，1例在第1步手术后出现大量腹腔积液，随之出现急性肾衰竭，未能完成第2步手术；其他4例均成功完成ALPPS。5例患者第1步手术情况：第1步手术平均时间为282min（240～320min）、第1步术中平均出血量为500mL（300～700mL）、第1步手术后平均FLR为457cm^3（338～697cm^3）、手术平均间隔时间15d（14～18d）、肝体积平均增长率为58％（46％-67％）、FLR／SLV的平均值为42％（32％-44％）。4例患者第2步手术平均时间为220min（200～260miObjective To investigate the sdety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） in the treatment of hepatoeellular carcinoma （HCC） with cirrhosis. Methods The retrospective cohort study was adopted. The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected. The surgical plan was determined according to preoperative liver function and liver functional reserve. The patients underwent portal vein （PV） ligation and liver partition in the first staged surgery. The second staged surgery was performed when growing future live remnant （FLR） came up to the standard of safe section by resean of computed tomography （CT） at 10, 14, 18 days ＇after the first staged surgery, and hemihepatectomy and hepatic segmentectomy were applied to patients. （ 1 ） The intraoperative situations were observed, including the severity of liver cirrhosis, first staged surgery time, volume of intraoperative blood loss and FLR in the first staged surgery, interval time of surgery, growth rate of liver volume, ratio of FLR and standard liver volume （SLV）, time and volume of intraoperative blood loss in the second staged surgery. （2） Pre- and post- operative biochemical indicators in the first and second staged surgeries were detected, including total bilirubin （TBil） and alanine phosphatase （ALT）. （3） Postoperative situations were observed, including occurrence of complications, results of pathological examination and duration of hospital stay. （4） The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015. Count data were represented as mean （range）. Results （ 1 ） Intraoperative situations ： of 5 patients, there were 1 patient with F3 of liver cirr

关 键 词：肝肿瘤 肝硬化 联合肝脏分隔和门静脉结扎的二步肝切除术 剩余肝脏体积 肝再生 

分 类 号：R735.7[医药卫生—肿瘤]