改良二步肝切除联合免疫靶向治疗临界可切除肝癌的临床疗效  

Clinical efficacy of modified two-stage hepatectomy combined with immunotherapy plus targeted therapy in the treatment of borderline resectable liver cancer

作　　者：姚鹏[1] 柴嘉穗 潘登 陈彦[1] 王旭 张宏杰[1] 李小争[1] Yao Peng;Chai Jiasui;Pan Deng;Chen Yan;Wang Xu;Zhang Hongjie;Li Xiaozheng(Department of Hepatobiliary Surgery,Yuncheng Central Hospital Affiliated to Shanxi Medical University,Yuncheng 044000,China)

机构地区：[1]山西医科大学附属运城市中心医院肝胆外科,运城044000

出　　处：《中华消化外科杂志》2024年第7期984-988,共5页Chinese Journal of Digestive Surgery

基　　金：山西省大健康产业高质量发展科研专项课题重点项目(DJKZXKT2023214)。

摘　　要：肝切除术是治疗肝癌最有效的方法,联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)为不可切除或临界可切除肝癌患者提供了可切除机会。ALPPS的2次手术间隔时间较短,围手术期并发症发生率与病死率均偏高。笔者总结1例一期行腹腔镜下右侧肝动脉联合门静脉结扎术,为预防肿瘤进展,一期手术后行免疫靶向治疗,3个月后成功行二期右半肝切除术,术后组织病理学检查为肝细胞癌伴大部分肿瘤区域坏死。术后随访15个月未见肿瘤复发。这提示肝动脉+门静脉结扎的二步肝切除联合免疫靶向治疗临界可切除肝癌有重要价值。Hepatectomy is the most effective method for the treatment of liver cancer.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)provides resectable opportunities for patients with unresectable or borderline resectable liver cancer.Traditional ALPPS procedures involve a short interval between two stages of the surgery,leading to a higher incidence of perioperative complications and mortality.The authors present a case of two‐stage hepatectomy.Initially,laparoscopic ligation of the right hepatic artery and portal vein was performed.To prevent tumor progression after the first stage of surgery,combined immunotherapy and targeted therapy were administered.Three months later,a successful right hemihepatectomy was performed.Postoperative histopathological examination revealed hepatocellular carcinoma with extensive tumor necrosis.A 15‐month follow‐up showed no tumor recurrence.This indicated that two‐stage hepatectomy including simultaneous ligation of the hepatic artery and portal vein,combined with two-stage hepatectomy plus immunotherapy and targeted therapy,showed considerable promise for borderline resectable liver cancer.

关 键 词：肝肿瘤 联合肝脏分隔和门静脉结扎的二步肝切除术 转化治疗 肝切除 多学科 

分 类 号：R735.7[医药卫生—肿瘤]