ALPPS联合混合现实全息影像成像治疗巨块型肝癌1例  

Associating liver partition and portal vein ligation for staged hepatectomy combined with mixed reality holographic imaging in treating massive hepatocellular carcinoma:a case report

作　　者：张隆鑫 陈晓鑫 姜开文[1] 王炜[1] ZHANG Longxin;CHEN Xiaoxin;JIANG Kaiwen;WANG Wei(DepartmentⅡof Surgery,Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510185,P.R.China)

机构地区：[1]广东省第二中医院外二科,广州510182

出　　处：《中国普外基础与临床杂志》2020年第10期1284-1289,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)与混合现实全息影像成像联合应用治疗巨块型肝癌的有效性。方法回顾性分析2019年1月广东省第二中医院行ALPPS联合混合现实全息影像成像治疗的1例巨块型肝癌患者的临床病理资料。结果1例58岁女性患者,术前腹部CT平扫+增强扫描见肝右叶一约12.0 cm×10.5 cm×17.0 cm巨大肿块,术前肝功能Child-Pugh A级。经术前评估后采用ALPPS治疗,Ⅰ期行联合肝脏离断及门静脉结扎术,术中辅以混合现实全息影像成像技术,术后第21天CT结果示肝左外叶体积占总肝体积比例约57.64%,Ⅰ期手术后第24天行Ⅱ期手术(肝癌根治术),术后予以化疗。手术过程顺利,无术后严重并发症发生。术后病理结果示:中分化肝细胞癌,多灶,最大径13 cm。术后6个月随访腹部CT平扫+增强扫描未见肝内新发病灶及其他转移灶。结论ALPPS联合混合现实全息影像成像治疗巨块型肝癌效果较好,混合现实全息影像成像能够立体呈现解剖细节,有助于术前估算剩余肝脏体积与术中定位,对患者术后恢复有积极意义。Objective To investigate the feasibility of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)combined with mixed reality holographic imaging in treating the massive hepatocellular carcinoma.Method The clinicopathologic data of 1 patient with massive hepatocellular carcinoma underwent the ALPPS combined with mixed reality holographic imaging in the Guangdong Second Traditional Chinese Medicine Hospital on January 2019 were retrospectively analyzed.Results A 58-year-old female patient,the preoperative CT scan and enhanced scan of the abdomen revealed a 12.0 cm×10.5 cm×17.0 cm mass in the right lobe of the liver,with preoperative Child-Pugh grade A liver function.The ALPPS was performed after the preoperative evaluation.The associating liver partition and portal vein ligation was performed and the mixed reality holographic imaging was used during the stageⅠoperation.On day 21 after the stageⅠoperation,the CT results of the volume of left lateral lobe of liver was approximately 57.64%.On day 24 after the stageⅠoperation,the patient underwent the stageⅡoperation(radical hepatectomy).The patient received the chemotherapy after the operation.The courses of those operations were successful.And no severe complications occurred after the operation.The postoperative pathological results showed a moderately differentiated hepatocellular carcinoma with multiple foci and a maximum diameter of 13 cm.Six months after the last operation,there was no new intrahepatic metastasis and other metastases were found.Conclusions ALPPS combined with mixed reality holographic imaging is effective in treatment of massive hepatocellular carcinoma.Mixed reality holographic imaging could show anatomical details with three dimensions,it is beneficial for estimating future liver reserve before operation and locating during operation,and there is also a positive significance of postoperative recovery.

关 键 词：肝部分切除术 混合现实全息影像成像 巨块型肝癌 剩余肝脏体积 

分 类 号：R735.7[医药卫生—肿瘤]