变异ALPPS联合下腔静脉重建治疗晚期肝泡型包虫病  

Variant ALPPS combined with inferior vena cava reconstruction for end-stage hepatic alveolar echinococcosis

作　　者：唐几超 杨冲 周果 杨洪吉 张宇 邓绍平 TANG Jichao;YANG Chong;ZHOU Guo;YANG Hongji;ZHANG Yu;DENG Shaoping(Clinical Medicine College,Southwest Medical University,Luzhou,Sichuan 646000,P.R.China;Organ Transplantation Center,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,P.R.China;Ultrasonic Department,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,P.R.China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]电子科技大学附属医院·四川省人民医院器官移植中心,成都610072 [3]电子科技大学附属医院·四川省人民医院超声科,成都610072

出　　处：《中国普外基础与临床杂志》2020年第9期1139-1144,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生计生委课题(项目编号:150192);四川省医学科学院·四川省人民医院临床研究及转化基金(项目编号:2017LY04)。

摘　　要：目的探讨变异的肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)联合下腔静脉(IVC)重建在晚期肝泡型包虫病(HAE)中的临床应用效果。方法回顾性分析四川省人民医院于2017年11月收治的1例行变异ALPPS联合IVC重建的晚期HAE患者的临床资料。结果患者术前CT检查提示肝内多发包虫病灶,侵及多个肝段并侵犯肝后下腔静脉及3支肝静脉,仅S6段保留完整的入肝及出肝管道系统,功能残肝体积占标准肝体积的24.9%。完善术前检查后行手术探查,一期结扎门静脉左支及右肝前叶支,增加S6段的门静脉供血,并部分劈裂肝脏。术后恢复顺利,无胆汁漏、感染等并发症发生。一期手术后6个月行二期手术,术前测得功能残肝体积/标准肝体积比值为48.3%。术中完整切除S1–5和S7–8肝段,并用人工血管重建肝后下腔静脉。患者于术后10 d出院,随访18个月期间生存状况良好,无复发及其他并发症发生。结论变异ALPPS联合IVC重建治疗终末期HAE是可行并且安全的。该术式是治疗终末期多发、巨大且残肝体积不足的HAE的有效尝试。Objective To explore the clinical application of variant associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)combined with inferior vena cava reconstruction for end stage hepatic alveolar echinococcosis(HAE).Method The clinical data of one case with HAE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in November 2017 was analyzed retrospectively.Results Computed tomography revealed that the three hepatic veins and retrohepatic inferior vena cava were invaded by multiple and giant hydatid lesions.Only the segment 6 retained the complete portal vein and hepatic vein return branch.Remnant liver volume/standard liver volume(RLV/SLV)of this patient was 24.9%.Surgical exploration was performed after preoperative examination.In the first stage,ligation of the left portal vein and the right anterior lobe portal vein were performed to increase portal blood supply at S6 while partial split of the liver.The patient recovered well after operation without complications such as bile leakage and infection.Six months after the first stage surgery,the second stage surgery was performed,and RLV/SLV measured before surgery was 48.3%.S1–5/S7–8 were completely removed and the hepatic inferior vena cava was reconstructed with artificial blood vessels.The patient was discharged on 10 days after operation,and there was no complications and relapses occurred during the 18 months follow-up period.Conclusions Variant ALPPS combined with inferior vena cava reconstruction is an effective attempt to treat end stage HAE with multiple and giant hydatid lesions and insufficient RLV.

关 键 词：肝泡型包虫病 肝脏离断和门静脉结扎的分阶段肝切除术 人工血管 下腔静脉重建 

分 类 号：R657.3[医药卫生—外科学]