摘要
目的探讨联合肝右静脉结扎的联合肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)治疗巨块型肝细胞癌(肝癌)的疗效。方法患者男,38岁,体重53kg,因“右上腹胀痛半月余,检查发现肝占位6d”入院。肝脏超声造影示肝右叶占位性病变。初步诊断:右半肝巨块型肝癌合并肝右静脉癌栓形成,BCLC分期C期,原发性肝癌中国分期Ⅲa期,肝功能Child-Pugh分级A级。患者签署知情同意书,符合医学伦理学规定。患者行联合肝右静脉结扎+ALPPS。第一期手术分离左、右半肝,结扎门静脉右支及肝右静脉。二期切除右半肝。结果一期手术时间414min,术中出血量200ml,术中未输血。术后主要并发症为腹腔积液,予特利加压素配合口服利尿药后好转。术后第7天左半肝体积增长至530ml,占标准肝脏体积的56%,术后第18天行二期手术。二期手术时间240min,术中出血量500ml,输注红细胞2U。Clavien-Dino并发症分级Ⅰ级,主要并发症为腹腔积液,予以护肝、输注白蛋白、利尿后好转。患者术后恢复顺利。结论联合肝右静脉结扎的ALPPS为合并肝右静脉癌栓、剩余肝脏体积不足的患者提供了新的手术方案参考。
Objective To evaluate the clinical efficacy of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)combined with right hepatic vein ligation in the treatment of massive hepatocellular carcinoma(HCC).Methods A 38-year-old male patient,weighed 53 kg,was admitted to hospital due to distending pain in the right upper abdomen for over half a month and liver-occupying lesions for 6 d.Contrast-enhanced ultrasound of liver indicated the right lobe-occupying lesion.Preliminary diagnosis:massive HCC of the right lobe with tumor thrombus in right hepatic vein,BCLC stage C,primary liver cancer stageⅢa of China and Child-Pugh grade A for liver function.The informed consent of the patient was obtained and the local ethical committee approval was received.The patient underwent the right hepatic vein ligation and ALPPS.In the first stage of operation,the left and right lobes were separated,and the right branch of portal vein and the right hepatic vein were ligated.The right lobe was resected in the second stage.Results The operation time of first stage was 414 min.The intraoperative blood loss was 200 ml.No blood transfusion was delivered during the operation.The postoperative complication was mainly ascites,which was relieved after using telipressin combined with oral diuretics.At postoperative 7 d,the volume of the left lobe increased to 530 ml,accounting for 56%of the standard liver volume.At postoperative 18 d,the second-stage operation was performed.The secondstage operation endured for 240 min.The intraoperative blood loss was 500 ml,and 2 U of red blood cells were infused.The complications were classified as Clavien-Dino grade I.The main complication was ascites,which was relieved after liver protection,albumin and diuresis were given.The patient recovered uneventful after operation.Conclusion ALPPS combined with the right hepatic vein ligation provides a new reference for the surgery of HCC patients with insufficient residual liver volume complicated with tumor thrombus in the right hepati
作者
陆开艺
徐邦浩
王继龙
梁立洲
卢婷婷
张灵
黄福灵
曾晶晶
郭雅
滕艳娟
彭民浩
文张
Lu Kaiyi;Xu Banghao;Wang Jilong;Liang Lizhou;Lu Tingting;Zhang Ling;Huang Fuling;Zeng Jingjing;Guo Ya;Teng Yanjuan;Peng Minhao;Wen Zhang(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Ultrasound,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Radiology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Pathology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Hepatobiliary Surgery,the 924th Hospital of People's Liberation Army,Guilin 541002,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2019年第4期329-334,共6页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金地区科学基金项目(81560387)
广西教育厅高校科学研究项目(LX20140557)
广西高校急诊医学重点实验室开放课题(GXJZ201501)
广西医疗卫生适宜技术开发与推广应用项目(S2018100)
广西医科大学第一附属医院“优秀医学英才”科研创新能力培养项目资助(180327)
