摘要
目的探讨行RFA或门静脉栓塞术（PVE）补救治疗射频辅助联合肝脏分隔和门静脉结扎的二步肝切除术（RALPPS）一期术后剩余肝体积（FLR）增长不良的合并肝硬化肝癌患者的临床疗效。方法采用回顾性描述性研究方法。收集2014年9月至2016年2月第三军医大学西南医院收治的5例行RFA或PVE补救治疗RALPPS一期术后FLR增长不良合并肝硬化肝癌患者的临床资料。标准肝脏体积（SLV）：613．0X体表面积＋162．8；体表面积=0．0071×身高＋0．0133×体质量。对FLR〈40％的肝癌患者行RALPPS。一期术中采用RFA在患侧和健侧肝叶间烧灼出1条凝固无血带，结扎门静脉右支。术后对于FLR增长不足的患者行经皮RFA或PVE补救治疗，刺激FLR增长，达到目标值后行二期肿瘤切除术。观察指标：（1）围术期并发症发生和死亡情况。Clavien—DindoⅢa级及以上并发症定义为主要并发症。（2）FLR变化及肿瘤进展情况。（3）术中情况。（4）随访情况。采用门诊随访，随访时间截至2016年2月。随访项目包括常规实验室检查、肿瘤标志物、影像学检查（腹上区增强CT或超声造影）等。正态分布的计量资料采用面±s表示。结果（1）围术期并发症发生和死亡情况：2例患者未行二期手术，其余3例患者完成二期手术。5例患者术后均无主要并发症发生。1例患者于二期术后并发肾衰竭及严重肺部感染死亡。（2）FLR变化及肿瘤进展情况：5例患者一期术前FLR为（329±80）cm^3，占SLV百分比为25％±5％。3例患者二期术前FLR为（533±45）cm^3，占SLV百分比为43％±3％，增长率为44％～113％，间隔期时间为（29．0±2．2）d。3例完成二期手术患者一期术后第1周FLR增长率为33．5％～68．9％；行RFA或PVE补救治疗前FLR1周增长率为1．2％～14．3％；治疗后FLR1周增长率为9．7％～29．8％。2例未行二期手术患者：1例一期术后
Objective To explore the clinical effect of remedial radiofrequency ablation （RFA） or portal vein cmbofization （PVE） combined with radiofrequency ablation-assistant associating liver partition and portal vein ligation for staged hepatectomy （RALPPS） in the treatment of patients with insufficient future liver remnant （FLR） after the first staged operation and hepatoeellular carcinoma （HCC） with cirrhosis. Methods The retrospective and descriptive cross-sectional study was adopted. The clinical data of 5 patients with insufficient FLR after the first staged of RALPPS and HCC with cirrhosis who underwent remedial RFA or PVE at the Southwest Hospital of the Third Military Medical University between September 2014 and February 2016 were collected. Standard liver volume （SLV） = 613.0 x body surface area （BSA） ＋ 162.8, BSA = 0.007 1 × height ＋ 0. 013 3 × body mass. Patients with FLR 〈40% received RALPPS. In the first staged operation, RFA was used to cauterize a coagulated avaseular area between the FLR and contralateral lobe, and then fight branch of portal vein was ligated. After the operation, remedial RFA or PVE was performed in patients with insufficient FLR. Once the FLR achieved the target value, the second staged RALPPS was performed. Observation indicators included （ 1 ） perioperative complications and death, complications in stage IIIa and above of Clavien-Dindo as main complications, （2） changes of FLR and tumor progression, （3） intraoperative situation, （4） follow-up. The follow-up using outpatient examination was performed up to February 2016, including laboratory examination, tumor markers and imaging examinations （enhanced scan of computed tomogxaphy in the epigastric region or ultrasound）. Measure-ment data with normal distribution were represented as x ± s. Results （ 1 ） Perioperative complications and death： of 5 patients, 2 didn＇t receive second staged RALPPS and 3 completed both stages. Five patients had no postoperative main complicati
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2016年第5期455-460,共6页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81272688）
重庆市应用和发展项目（cste2014yykfB10002）
西南医院创新课题基金（SWH2014LC14）
关键词
肝肿瘤
肝硬化
联合肝脏分隔和门静脉结扎的二步肝切除术
射频消融术
门静脉栓塞术
剩余肝脏体积
vLiver neoplasms
Cirrhosis
Associating liver partition and portal vein ligation for staged hepatectomy
Radiofrequency ablation
Portal vein embolization
Future liver remnant
