摘要
目的分析肝脏离断和门静脉结扎的二步(二期)肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)围手术期肝功能及并发症的特点。方法对26例因中晚期肝癌行ALPPS术的患者,在围手术期观察肝功能各项指标值及其变化趋势;密切观察并发症的发生、发展、处理及转归情况。结果肝功能的变化趋势显示,一期及二期手术后,谷丙转氨酶均在术后第1~2天达到高峰,随后迅速下降;总胆红素在一期手术后第3~4天达到峰值,二期手术后第1~5天均维持在较高水平,随后逐渐降至正常。一例患者在术后6天开始出现转氨酶逐步降低、胆红素进行性升高的"酶胆分离"现象,后发展为肝功能衰竭。并发症方面,发生率最高的为胸腔积液,一期手术后9例(34.6%)并发胸腔积液,8例发生在术后第3~7天,其中1例行胸腔穿刺置管引流;二期手术后,12例(46.2%)发生胸腔积液,10例发生在术后第8~12天,其中11例行胸腔穿刺抽液或引流;感染性并发症的发生率在一期和二期手术后分别为15.4%、26.9%,其中肺部感染居第一位。结论ALPPS术后,转氨酶和胆红素在术后一周内呈现出先升后降的变化趋势;胸腔积液是术后最常见的并发症,一期手术后第1周易发,二期手术后第2周易发;积极预防肺部感染有利于降低围手术期感染并发症率。
Objective To analyze the characteristics of perioperative liver function and complications in hepatocellular carcinoma(HCC)patients undergoing associating liver partition and portal vein ligation for staged hepatectomy(ALPPS,two-stage,hepatectomy and portal vein ligation).Methods Twenty-six patients undergoing ALPPS due to advanced HCC in our hospital from July 2014 to June 2017 were enrolled in this study.The indexes of liver function and their trends were observed in the perioperative period.The occurrence,development,treatment and outcomes of complications were also observed.Results The trend of liver function showed that after the first and second operations,alanine aminotransferase(ALT)level reached a peak on the first 1~2 d after surgery,and then decreased rapidly;total bilirubin(TB)reached the highest level on the 3 rd^4 th days after the first operation,maintained at a high level on the first 1 to 5 d after the second stage of surgery,and then gradually decreased to normal.One patient developed a"bilirubin-transaminase discrepancy"phenomenon in which the transaminase levels were gradually decreased while TB level was progressively elevated in 6 d after the secondary operation,and then developed into liver failure.In terms of complications,the highest incidence was pleural effusion,including 9 cases(34.6%,with 8 on the 3 rd to 7 th days after operation,and thoracic drainage in 1 case)in the first stage,and 12 cases(46.2%,with 10 cases on the 8 th to 12 th days postoperatively,and thoracic puncture drainage or drainage in 11 case)after the second operation.The incidence of infectious complications was 15.4%in the first phase and 26.9%after the second operation,and the lung infection was most common.Conclusion After ALPPS,transaminase and bilirubin show a trend of first rise and then falling within 1 week after operation.Pleural effusion is the most common complication after operation,and easy to occur in the first week after the first operation and second week after the second stage of surgery.Therefore,act
作者
曹永
揭彬
郑树国
曹利
马丽
季渝军
CAO Yong;JIE Bin;ZHENG Shuguo;CAO Li;MA Li;JI Yujun(Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China;Department of Behavioral Medicine, School of Psychology, Army Medical University (Third Military Medical University), Chongqing, 400038, China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2019年第15期1491-1496,共6页
Journal of Third Military Medical University
关键词
原发性肝癌
联合肝脏离断和门静脉结扎的二步/二期肝切除术
ALPPS
肝功能
并发症
primary liver cancer
two-step/two-stage hepatectomy combined with liver disconnection and portal vein ligation
ALPPS
liver function
complications
