ALPPS在肝泡型包虫病中的应用  

Application of associating liver partition and portal vein ligation for two-stage hepatectomy in hepatic alveolar echinococcosis

作　　者：王瑞涛[1] 刘昌[1] 张晓刚[1] 万永[1] 曲凯[1] 顾静娴[1] 郝万静 Wang Ruitao;Liu Chang;Zhang Xiaogang;Wan Yong;Qu Kai;Gu Jingxian;Hao Wanjing(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华肝脏外科手术学电子杂志》2018年第2期127-132,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：陕西省社会发展科技攻关项目(2016SF-204);西安交通大学新医疗新技术支持项目(2015XJ-10)

摘　　要：目的探讨联合肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)治疗肝泡型包虫病的安全性和有效性。方法回顾性分析2015年6月至2016年1月在西安交通大学第一附属医院行ALPPS的2例肝泡型包虫病患者临床资料。患者均签署知情同意书,符合医学伦理学规定。例1男,47岁;例2女,24岁,均诊断为"肝包虫病"。例1患者第一阶段结扎门静脉右支,离断肝左内叶与左外叶间肝实质;第二阶段行肝右三叶切除术。例2患者第一阶段行右半肝切除,离断肝左内叶和左外叶间肝实质;第二阶段行肝左外叶切除术。结果例1患者第一阶段手术时间540 min,出血量2 000 ml,术中输注RBC 8 U,血浆800 ml;第二阶段手术时间660 min,出血量4 500 ml,输注RBC 32 U,血浆2 000 ml。第一阶段术后恢复顺利,第二阶段术后出现胆漏,行经皮经肝胆道引流术恢复。例2患者第一阶段手术时间405 min,出血量2 000 ml,术中输注RBC 10 U,血浆2 000 ml;第二阶段手术时间190 min,出血量1 000 ml,输注RBC 4 U,血浆800 ml。术后恢复顺利。2例患者术后随访24个月,生存状况良好,无并发症发生及包虫复发。结论 ALPPS为剩余肝脏体积不足的复杂肝泡型包虫病手术治疗提供了新的术式选择。Objective To explore the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in treating hepatic alveolar echinococcosis.Methods Clinical data of 2 patients with hepatic alveolar echinococcosis undergoing ALPPS in the First Affiliated Hospital of Xi'an Jiaotong University between June 2015 and January 2016 were analyzed retrospectively.The informed consents of both patients were obtained and the local ethical committee approval was received.Case 1 was male,47 years old.Case 2 was female,24 years old.Both were diagnosed as hepatic echinococcosis.For case 1,ligation of the right portal vein and division of the left medial lobe and left lateral lobe were performed in the first stage,and resection of 3 right lobes was performed in the second stage.For case 2,right hemihepatectomy and division of the left medial lobe and left lateral lobe were performed in the first stage,and hepatic left lateral lobectomy was performed in the second stage.Results For case 1 in the first stage,the operation duration was 540 min,blood loss was 2 000 ml,intraoperative RBC infusion was 8 U,and plasma infusion was 800 ml;in the second stage,the operation duration was 660 min,blood loss was 4 500 ml,RBC infusion was 32 U,and plasma infusion was 2 000 ml.Case 1 recovered well after the first stage operation,but suffered from bile leakage after the second stage operation,then received percutaneous transhepatic biliary drainage and recovered afterward.For case 2 in the first stage,the operation duration was 405 min,blood loss was 2 000 ml,intraoperative RBC infusion was 10 U,and plasma infusion was 2 000 ml;in the second stage,the operation duration was 190 min,blood loss was 1 000 ml,RBC infusion was 4 U,and plasma infusion was 800 ml.The patient recovered well after operation.Both 2 patients were followed up for 24 months after operation and lived in a good condition,no complication or recurrence of hydatid disease was observed.Conclusion ALPPS has provided a new option for the operative

关 键 词：棘球蚴病 肝 ALPPS 剩余肝脏体积 肝切除术 

分 类 号：R657.3[医药卫生—外科学]