按照损伤控制原则改进ALPPS手术的可行性及效果  

Clinical evaluation of modified ALPPS based on risk-reduced strategy

作　　者：孔亚林 李捷[2] 孔令红 赵刚 王成 赵静 何晓军 韩旭[2] 刘承利 KONG Yalin;LI Jie;KONG Linghong;ZHAO Gang;WANG Cheng;ZHAO Jing;HE Xiaojun;HAN Xu;LIU Chengli(Department of Hepatobiliary Surgery, Chinese PLA Air Force Medical Center Affiliated to Air Force Military Medical University, Beijing 100142, China;Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo 255036, Shandong, China)

机构地区：[1]空军军医大学附属空军特色医学中心肝胆外科,北京100142 [2]淄博市中心医院肝胆外科,山东淄博255036

出　　处：《西部医学》2022年第2期265-269,共5页Medical Journal of West China

基　　金：国家科技部科技支撑计划课题(2012BAI15B08)。

摘　　要：目的探讨通过损伤控制原则对联合肝脏离断和门静脉结扎的分期肝脏切除术(ALPPS)手术方式进行改进,并系统评价该手术方式的有效性和安全性。方法回顾性分析近5年来空军军医大学附属空军特色医学中心与淄博市中心医院联合开展的ALPPS手术治疗患者65例。损伤控制策略包括病例纳入标准的修订、精确的剩余肝脏体积评估和手术规划、微创技术的应用等。统计分析围手术期指标、功能性剩余肝脏体积增生、术后并发症的发生率及总体生存率。结果共计60例患者接受了损伤控制性ALPPS手术,所有患者术后恢复良好。一期手术后无严重并发症发生,剩余肝脏体积平均增加(179.3±72.4)cm^(3),增大比为(45.7±22.9)%与功能性剩余肝脏体积增加值差异无统计学意义(P>0.05)。患者术后总体生存时间为22.4(3.2~31.4)月。结论通过采用损伤控制性风险降低方法,ALPPS可以成为治疗复杂肝脏恶性肿瘤的可靠方法,该手术方法可以使没有足够剩余肝脏体积的肝癌患者获得较长生存期。Objective To evaluate the efficacy and safety of modified ALPPS procedure.Methods Patients who were performed ALPPS in Chinese PLA Air Force Medical Center and Zibo Central Hospital in recent 5 years were retrospectively reviewed.The modified strategy included strict patient selection,precise future liver remnant(FLR)assessment and operation planning,and usage of minimally invasive methods.Data including clinical records,functional FLR increase,complications,and overall survival(OS)were analyzed.Results Sixty patients underwent modified ALPPS procedure and recovered well.No severe complications happened after the 1-stage operation,and the increasing FLR was 179.3 cm^(3)(±72.4 cm^(3)),with similar functional FLR increase.The OS was 20.0 month(±4.5month).Conclusion ALPPS could be a feasible treatment for complex liver tumors by risk-reduced modification.It could be expected to provide long-term survival for patients without enough FLR.

关 键 词：联合肝脏离断和门静脉结扎分期肝切除术 肝恶性肿瘤 风险 并发症 总体生存率 

分 类 号：R735.7[医药卫生—肿瘤]