MDT在联合肝脏离断和门静脉结扎的二步肝切除术中的运用  

Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy

作　　者：李屈进 刘作金[1] 涂兵[1] 龚建平[1] 刘皎 LI Qujin;LIU Zuojin;TUBing;GONG Jianping;LIU Jiao(Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,P,R.China)

机构地区：[1]重庆医科大学附属第二医院肝胆外科,重庆400010

出　　处：《中国普外基础与临床杂志》2018年第7期852-858,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：赛生医药(中国)有限公司

摘　　要：目的探讨多学科协作团队(multi-disciplinary team,MDT)模式在无法一期手术切除的原发性巨块型肝癌患者行联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)中的应用价值。方法患者术前行腹部CT检查提示一约90.9 mm×75.5 mm×77.5 mm大的肝右叶巨大占位,考虑为原发性肝癌,经放射影像科、肝病感染科、肿瘤科、麻醉科及肝胆外科团队协作讨论后决定拟采取ALPPS法治疗,第一步在全身麻醉下行剖腹探查+门静脉右支结扎联合左右半肝离断+射频消融+胆囊切除术;第一步手术后第45天在全身麻醉下行腹腔粘连松解+肝右叶切除术。结果在两步手术间期患者出现肝功能衰竭、肝性脑病、左肝增生欠佳等情况,MDT通力协作、群策群力,共同应对,患者顺利完成了ALPPS手术,做到了肝癌的R0切除,术后经多次MDT协助治疗相关并发症,患者恢复良好,术后2个月随访复查未见明显肿瘤复发与转移。结论在无法一期手术切除的原发性巨块型肝癌患者行ALPPS的治疗过程中,MDT模式将更加有利于临床集思广益,给予患者最佳治疗,收益较佳。Objective To explore application value of multi-disciplinary team （MDT） model in patient underwent associating liver partition and portal vein occlusion for staged hepatectomy （ALPPS）. Methods A huge mass of liver right lobe about 90.9 mm×75.5 min×77.5 mm was found by the preoperative abdominal CT examination, which was considered as the primary liver cancer. The ALPPS was decided to perform through the discussion by the Departments of Radiology, Anesthesiology, Infectious disease, Oncology, and Hepatobiliary surgery. The first step operation included the exploratory laparotomy, associating ligation of the right branch of portal vein and disconnection of left and right hemi liver, radiofrequency ablation, and cholecystectomy. The second step operation was performed at 45 d after the first step operation, which included the release of the abdominal adhesion and the resection of the right lobe of liver. Results During the period of the two steps surgeries, though the patient had the liver failure, hepatic encephalopathy, and poor proliferation of the left lobe of liver, and so on, the ALPPS was finished smoothly and the R0 resection was achieved through the collboration of MDT. After the surgery, the related complications were treated by the MDT, the patient got great recovery and no recurrence or metastasis occurred during the following-up. Condusion It is feasible to use ALPPS in treatment of primary giant liver cancer under MDT model, it will be more conducive to clinical brainstorming for the best treatment and better income of patient.

关 键 词：多学科协作团队模式 原发性巨块型肝癌 联合肝脏离断和门静脉结扎的二步肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]