AIPPS技术在肝癌合并肝硬化手术中的应用  

Application of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） incirrhotic patients with hepatocellular carcinoma

作　　者：徐意瑶[1] 卢欣[1] 杨华瑜[1] 毛一雷[1] 桑新亭[1] 赵海涛[1] 徐海峰[1] 迟天毅[1] 杜顺达[1] 钟守先[1] 黄洁夫[1] 

机构地区：[1]中国医学科学院北京协和医院肝脏外科,100730

出　　处：《中华普通外科杂志》2016年第7期534-537,共4页Chinese Journal of General Surgery

摘　　要：目的探讨肝细胞肝癌合并肝硬化病例实施联合肝脏离断和门静脉结扎的二步肝切除术（associatingliverpartitionandportalveinligationforstagedhepatectomy，ALPPS）的安全性和可行性。方法2014年9月至2015年6月，北京协和医院肝脏外科收治巨块型肝癌合并肝硬化行ALPPS手术病例共6例，术后通过数字减影血管成像技术进行随诊。结果全部6例病例第一步手术后1～4周残肝体积显著增大[（0．36±0．07）L比（0．58±0．14）L，P〈0．05]，均完成两步手术且未发生严重并发症；两步手术平均间隔20．7d；第一步手术中出血量及输血量与同期右半肝切除术比较无明显差异。结论ALPPS技术对于残肝体积不足的巨块型肝癌合并肝硬化的病例安全、可行，为这类患者提供了手术治疗的机会。Objective To study the safety and feasibility of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） applied to patients with hepatocellular carcinoma combined with liver cirrhosis. Methods Six eases of huge hepatocellular carcinoma with liver cirrhosis underwent ALPPS at Department of Liver Surgery in Peking Union Medical College Hospital from September 2014 to June 2015. Patients were followed up by digital subtraction angiography （ DSA）. Results The remnant liver volumes of all the 6 patients significantly increased within 1 -4 weeks after the first stage [ （0. 36 ± 0. 07 ） L vs. （0. 58 ± 0. 14） L,P 〈 0. 05 ] , and all of them had completed the second stage without any severe complications. The average interval between the two stages was 20. 7 days. There was no significant difference between the amount of blood loss and blood transfusion in the first stage and of those undergoing one-stage right hemihepateetomy. Conclusion ALPPS is safe and feasible for cirrhotic patients with huge hepatoeellular carcinoma with an otherwise boardline remnant of the liver.

关 键 词：癌 肝细胞 肝硬化 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]