全腹腔镜ALPPS治疗小儿巨块型肝脏肿瘤  

Total laparoscopic ALPPS in the treatment of massive liver tumor

作　　者：余辉[1] 郑百俊[1] 高亚[1] 龚伟[1] 吴宣林[1] 刘瑶[1] 熊娜 余强[1] 李鹏[1] 郭新奎[1] Yu Hui;Zheng Baijun;Gao Ya;Gong Wei;Wu Xuanlin;Liu Yao;Xiong Na;Yu Qiang;Duan Yitao;Li Peng;Guo Xinkui(Department of Pediatric Surgery,the Second Affiliated Hospital,Xi'an Jiaotong University,No 157,Xi Wu Road,Xi'an 710006,Shaanxi,China)

机构地区：[1]西安交通大学第二附属医院小儿外科,陕西省西安市710006

出　　处：《临床小儿外科杂志》2021年第7期635-640,657,共7页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(编号:82071692、81770513、81701501);陕西省科技新星(编号:2019KJXX-044);陕西省自然科学基金(编号:2020JM-407);西安交通大学第二附属医院科技新苗项目[编号:RC(XM)201703]。

摘　　要：目的探讨采用全腹腔镜联合肝脏分隔和门静脉结扎的二步肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)治疗小儿巨块型肝脏肿瘤的可行性,并总结治疗经验。方法回顾性分析2020年7月西安交通大学第二附属医院小儿外科收治的1例右肝巨块型肝脏肿瘤患者接受全腹腔镜ALPPS的临床资料,分析围手术期资料和手术情况,评价其临床应用价值。结果术前准备完善后,分别于2020年7月11日、7月24日顺利施行全腹腔镜下ALPPSⅠ期、Ⅱ期手术。其中ALPPSⅠ期手术时间3 h,围手术期未输血;术后3 d内体温波动于36.3~37.5℃;术后第10天复查肝功能正常;术后超声检查提示门静脉左支通畅,内径5.6 mm、流速42 cm/s,术后第3天残肝容积由221 cm^(3)增大至394 cm^(3),增长率为78.28%;ALPPSⅡ期手术时间6 h,右半肝完整切除,输血600 mL;术后3 d内体温波动于36.3~37.8℃,术后第12天肝功能正常;术后腹腔最大引流量175 mL,后逐渐维持在20 mL/d,术后第13天夹管出院。术后病理证实为肝脏间叶错构瘤。结论借助全腹腔镜可安全、有效地开展ALPPS治疗小儿巨块型肝脏肿瘤,预留残肝短期内可代偿肥大,为既往巨块型肝脏肿瘤残肝容积不足以施行完整切除的患者提供了希望。Objective To investigate the feasibility and therapeutic experience of total laparoscopic associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for massive liver tumor in children.Methods The clinical data of the girl diagnosed with massive liver tumor and treated by total laparoscopic ALPPS in the pediatric surgery department of the Second Affiliated Hospital of Xi'an Jiaotong University in July 2020 was retrospectively analyzed.The perioperative laboratory,imaging data and operation implementation were analyzed to evaluate the clinical application value of this operation in the treatment of pediatric massive liver tumor.Results The stageⅠandⅡof ALPPS were performed on July 11 and 24,2020,respectively.The operation time of stage I was 3 hours,and there was no blood transfusion during the perioperative period.The body temperature fluctuated 36.3-37.5℃within 3 days after operation,and the liver function returned to normal at the 10th days after operation.The postoperative ultrasound examination showed that the left portal vein was unobstructed,the inner diameter was 5.6 mm,the flow rate was 42 cm/s,and the volume of remnant liver increased from 221 cm^(3) to 394 cm^(3) on the third day after operation,with an increase rate of 78.28%.The operation time of stageⅡwas 6 hours.The liver function returned to normal at 36.3-37.8℃within 3 days after operation,and the maximum abdominal drainage volume was 175 mL,and then gradually maintained at 20 mL/day.The catheter was clamped and discharged on the 13th day after operation.Conclusion Total laparoscopic surgery in children can safely and effectively carry out ALPPS for massive liver tumors,and reserve the residual liver for compensatory hyperplasia in a short period of time.It provides hope for children with massive liver tumors whose residual liver volume is not enough for complete resection,and is expected to become a new method for the treatment of massive liver tumors.

关 键 词：腹腔镜检查 肝肿瘤 肝切除术 儿童 

分 类 号：R735.7[医药卫生—肿瘤] R726.1[医药卫生—临床医学]