摘要
目的联合肝脏离断和门静脉结扎二步肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)可以提高肝脏恶性肿瘤根治性切除率,但并发症的发生率和围手术期的病死率较高。本研究通过损伤控制原则下的ALPPS—期手术改进,系统评价该术式的安全性及有效性。方法通过病例的精准纳入、精确的剩余肝脏体积评估和一期手术规划以及微创技术的应用,对ALPPS—期手术进行损伤控制,统计分析手术指标、功能性剩余肝脏体积增生、术后并发症的发生率及总体生存率。结果空军特色医学中心联合北京天坛医院共计60例患者接受了损伤控制性一期改良式ALPPS手术,一期术后无严重并发症发生,手术时间(146.3±22.7)min,出血量(148.5±27.8)ml,剩余肝脏体积平均增加(179.3±72.4)cm3,与功能性剩余肝脏体积的增加差异无统计学意义。二期手术时间(287.5±48.2)min,出血量(615.7±62.4)ml,严重并发症发生率为16.7%,患者术后中位生存时间为22.4个月。结论通过对一期手术采用损伤控制性改进方法,ALPPS可以成为治疗复杂肝脏恶性肿瘤的可靠方法,使没有足够剩余肝脏体积的肝癌患者获得长期生存。
Objective To evaluate the safety and efficacy of modified 1-stage operations under the risk-reduced strategy for ALPPS procedures.Methods Modified ALPPS procedures were performed based on strict patient selection,precise future liver remnant(FLR)assessment,operation planning of lst-stage operations,and employment of minimally invasive methods.Such clinical data as clinical records,functional FLR increase,complications and overall survival(OS)was analyzed.Results Sixty patients underwent modified ALPPS procedures at the Air Force Medical Center,Beijing Tiantan Hospital and Zibo Central Hospital.No severe complications occurred after the lst-stage operations.The duration of the lst-stage operations was(146.3±22.7)min and the blood loss was(148.5±27.8)ml.The average increase of FLR was(179.3±72.4)cm3 along with functional FLR increases.The duration of the 2nd-stage operations was(287.5±48.2)min,the blood loss was(615.7±62.4)min,and the incidence of severe complications was 16.7%.The OS was 22.4 months.Conclusion ALPPS can be a feasible approach tocomplicated liver tumors via risk-reduced modification in the 1-stage operations.This treatmentis expected to provide long-term survival for patients without enough FLR.
作者
孔亚林
邢颖
李捷
刘承利
何晓军
王成
赵刚
孔令红
韩旭
张洪义
KONG Yalin;XING Ying;LI Jie;LIU Chengli;HE Xiaojun;WANG Cheng;ZHAO Gang;KONG Linghong;HAN Xu;ZHANG Hongyi(Department of Hepatobiliary Surgery,Air Force Medical Center,Beijing 100142,China)
出处
《空军航空医学》
2022年第3期62-66,F0003,共6页
AVIATION MEDICINE OF AIR FORCE
关键词
联合肝脏离断和门静脉结扎二步肝切除术
肝恶性肿瘤
风险
并发症
生存率
associating liver partition and portal vein ligation for staged hepatectomy
liver malignant tumor
risk
complication
survival
