摘要
目的探讨联合门静脉切除重建的肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)治疗肝内胆管细胞癌(ICC)的安全性和疗效。方法患者女,64岁,因体检发现“肝内胆管扩张1周”入院。初步诊断为肝右叶ICC伴胆管扩张。患者签署知情同意书,符合医学伦理学规定。患者ICGR150.031,术前预测左半肝的剩余肝体积(FLR)为325 ml,占标准肝体积36.1%,经综合评估行ALPPS。一期术中发现门静脉左支受侵犯,切除受侵犯门静脉壁并整形,行门静脉主干和左支端端吻合重建;离断右半肝肝实质,将门静脉右支切断闭合;同时行胆管-空肠吻合术。术后15 d二期行右半肝+右尾状叶切除术。结果一期手术时间780 min,术中出血量600 ml,术中未输血。术后出现发热、胆漏,予抗感染、通畅引流后好转。术后15 d左半肝体积增大至492 ml,占标准肝体积的54.8%。二期手术时间270 min,术中出血量700 ml,输注红细胞4 U。术后出现发热、低钠血症、腹腔积液等并发症,对症处理后好转出院。术后半个月复查CT,FLR进一步增大至624 ml,占标准肝体积的69.5%。术后随访至2019年2月26日无复发、转移征象。结论联合门静脉切除重建的ALPPS可使部分门静脉受侵犯的ICC患者获得R0切除的机会,为提高围手术期安全性,应严格筛选合适病例,进行精准术前评估以及围手术期管理。
Objective To evaluate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)combined with portal vein resection and reconstruction in the treatment of intrahepatic cholangiocarcinoma(ICC).Methods A 64-year-old female patient was admitted to our hospital due to intrahepatic bile duct dilatation for 1 week found by physical examination.She was initially diagnosed with ICC in the right lobe complicated with bile duct dilatation.The informed consent of the patient was obtained and the local ethical committee approval was received.The ICGR15 was 0.031.Preoperatively,the volume of future liver remnant(FLR)of left lobe was predicted as 325 ml,accounting for 36.1%of the standard liver volume.ALPPS was performed after comprehensive evaluation.During the first-stage operation,left branch of portal vein was found invaded,the invaded portal vein wall was excised and reshaped,and the portal vein trunk and the left branch were end-to-end anastomosed.The liver parenchyma of right lobe was resected and the right branch of portal vein was resected and closed.Cholangiojejunostomy was performed simultaneously.Right hemihepatectomy combined with right caudate lobectomy was performed at 15 d after the first-stage operation.Results The first-stage operation time was 780 min and the intraoperative blood loss was 600 ml without intraoperative blood transfusion.Fever and bile leakage occurred after operation,which were mitigated after antiinfection and drainage.At postoperative 15 d,the left lobe volume increased to 492 ml,accounting for 54.8%of the standard liver volume.The second-stage operation time was 270 min,the intraoperative blood loss was 700 ml and 4 U red blood cells were infused.Postoperative complications,such as fever,hyponatremia and ascites,were observed,which were healed after symptomatic treatments.CT scan at postoperative 15 d demonstrated that FLR further increased to 624 ml,accounting for 69.5%of the standard liver volume.During postoperative follow-up until Febr
作者
李健
文张
徐邦浩
郭雅
滕艳娟
张灵
卢婷婷
曾晶晶
彭民浩
Li Jian;Wen Zhang;Xu Banghao;Guo Ya;Teng Yanjuan;Zhang Ling;Lu Tingting;Zeng Jingjing;Peng Minhao(Department of Hepatobiliary Surgery,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 Ultrasound,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)
出处
《中华肝脏外科手术学电子杂志》
CAS
2020年第1期62-66,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
国家自然科学基金(81560387)
广西教育厅高校科学研究项目(LX20140557)
广西医疗卫生适宜技术开发与推广应用项目(S2018100)
广西高校急诊医学重点实验室开放课题(GXJZ201501)
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(180327)。
关键词
胆管肿瘤
肝切除术
门静脉
Bile duct neoplasms
Hepatectomy
Portal vein
