腹腔镜辅助微波消融后行ALPPS治疗原发性肝癌的临床疗效观察  

Clinical observation of laparoscopic-assisted microwave ablation combined with ALPPS in the treatment of primary hepatic carcinoma

作　　者：首志雄[1] 郑达武[1] 梁咏荣 蒋居毅 SHOU Zhixiong;ZHENG Dawu;LIANG Yongrong;JIANG Juyi(Department of Hepato-Pancreato-Biliary Surgery,Qinzhou First People’s Hospital,Qinzhou,the Guangxi Zhuang Autonomous Region 535000,P.R.China)

机构地区：[1]广西钦州市第一人民医院肝胆胰外科,广西钦州535000

出　　处：《中国普外基础与临床杂志》2023年第8期939-943,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(项目编号:Z202000471);广西壮族自治区临床重点专科建设项目(项目编号:桂卫医发[2020]17号)。

摘　　要：目的 评估腹腔镜辅助微波消融后行联合肝脏离断和门静脉结扎的二步肝切除术(associating liver partition and portalveinligation for staged hepatectomy,ALPPS)治疗无法行一期根治性肝切除手术的原发性肝癌的有效性和安全性。方法 回顾性分析2019年1月至2021年6月期间于广西钦州市第一人民医院肝胆胰外科行腹腔镜辅助微波消融联合ALPPS治疗的12例原发性肝癌患者的临床资料。患者均有残肝体积(future live remnant,FLR)不足且合并有不同程度肝硬化,第1步在腹腔镜辅助下行负荷瘤肝叶门静脉结扎,同时在腹腔镜超声的引导下使用微波消融对左右半肝进行肝实质分隔,而不进行肝实质分割,其余操作同经典ALPPS。结果 12例患者均顺利完成手术。全组患者均完成2步手术治疗,第1步手术时间为90~130 min、(110.25±35.34)min;出血量为80~140 mL、(100.37±42.24)mL。第1步到第2步的间隔时间为12~16 d、(14.0±2.5)d,FLR/标准肝体积(standard liver volume,SLV)增长至(58.00±3.30)%。第2阶段手术时间为120~180 min、(150±30)min;出血量为300~1 200 mL、(453.50±107.70)mL;术后住院时间11~16 d、(14±2)d;其中有1例患者术中输去白红细胞悬液4 U,3例出现胸腹水,未出现肝功能衰竭、严重感染等严重并发症,无死亡病例。总住院时间为14~22 d、(17±3)d。与第1步术前比较,第1步术后第1天患者的白细胞计数、总胆红素水平和谷丙转氨酶水平增高(P<0.05),经治疗后第1步术后第5天除谷丙转氨酶外其余指标均恢复正常。与第2步术前比较,第2步术后第1天白蛋白和血红蛋白水平均有不同程度下降(P<0.05),白细胞计数、总胆红素、凝血酶原时间和谷丙转氨酶水平均有不同程度升高(P<0.05),术后第5天患者各项指标均逐渐恢复到正常范围。所有患者均获访,随访时间6~30个月、(20±6)个月,2例分别于术后6.2个月和13个月因肿瘤复发转移而死亡;其他患者未见复发,�Objective To evaluate the effectiveness and safety of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)combined with laparoscopic-assisted microwave ablation(Lap-MWA)for the liver resection in the treatment of unresectable primary hepatic carcinoma.Methods This study analyzed the clinical data of 12 hepatic carcinoma patients who underwent ALPPS combined with Lap-MWA for the liver resection from January 2019 to June 2021 in the Department of Hepato-Pancreato-Biliary Surgery of Qinzhou First People’s Hospital.The patients had insufficient future liver remnant(FLR)and different degrees of liver cirrhosis.The 1-stage ALPPS was to perform after the laparoscopic-assisted ligation of the portal vein of the loaded tumor.At the same time,the microwave ablation was used for the liver parenchyma segmentation under the guidance of laparoscopic ultrasound(LUS)without separating liver parenchyma.Other steps were the same as classic ALPPS.Results All the 12 patients successfully completed the operation.The 1-stage ALPPS lasted 90–130 min,(110.25±35.34)min;the blood loss was 80–140 mL,(100.37±42.24)mL.The interval between 2 stages was 12–16 d,(14.0±2.5)d.The FLR/standard liver volume(SLV)increased to(58.00±3.30)%.The 2-stage ALPPS lasted 120–180 min,(150±30)min;the blood loss was 300–1200 mL,(453.50±107.70)mL;the hospital stay after 2 stages of ALPPS operations was 11–16 d,(14±2)d.Among all patients,4 U of leukocyte suspension was transfused in 1 patient,and pleural ascites occurred in 3 patients.There were no serious complications such as liver failure and severe infection,and no death cases.The total hospital stay was 14–22 d,(17±3)d.After the 1-stage ALPPS,the total bilirubin,white blood cells,glutamic-pyruvic transaminase level increased(P<0.05),and total bilirubin and white blood cells gradually returned to the normal level on the 5th day after 1-stage ALPPS.On the 1st day after finishing the 2-stage ALPPS,albumin and hemoglobin decreased,while white blood cells,tota

关 键 词：原发性肝癌 腹腔镜辅助微波消融 联合肝脏离断和门静脉结扎的二步肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]