摘要
目的 提供联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)应用于门静脉癌栓病例中的经验,初步探讨其在门静脉癌栓病例治疗中的价值和进一步发展方向.方法 对解放军总医院肝胆外科2015年7月-2016年12月收治的3例应用于门静脉癌栓的ALPPS手术进行回顾性分析,采集患者基本信息、术前门静脉癌栓分型、术前肝功能Child-Pugh分级、ICG试验结果、预留肝体积、预留肝体积增长率、两期手术的手术时间、出血量、术后并发症情况、术后生存情况等关键临床数据,并结合文献进行讨论分析.结果 3例患者均完成ALPPS手术.根据门静脉癌栓的程树群分型,Ⅱ型1例,Ⅲ型2例.一期术前肝功能均为Child-Pugh A级,ICG R15平均为7.3％(4.2％～11.0％),平均预留肝体积387 ml(333 ～484 ml).两期手术平均间隔时间为24.7 d(9～50 d),平均预留肝体积的增长率为50.3％ (24.4％ ～ 82.3％).术后Clavien-DindoⅢ级以上的并发症1例,未出现死亡患者.截至2017年2月,2例患者因肿瘤复发行肝动脉化疗栓塞治疗,效果良好.所有患者均生存情况良好.解剖二期手术标本,均见癌栓坏死.结论 对于门静脉癌栓Ⅱ型和Ⅲ型的低预留肝体积患者,ALPPS是一种能够有效控制癌栓、提高根治性切除率的有价值的手术方式,结合肝动脉化疗栓塞等治疗方式有望进一步提高治疗效果.
Objective To provide the practical experience of association of liver partition and portal vein ligation for staged hepatectomy(ALPPS) procedure in portal vein tumor thrombosis(PVT) cases,and to explore its value in PVTT therapy.Methods Three cases of ALPPS were applied to PVTT in Department of Hepatobiliary Surgery of PLA General Hospital from 2015 to 2016.The patients data were retrieved and analyzed retrospectively,including the basic information,preoperative PVTT classification,preoperative Child-Pugh classification,ICG test results,future liver remnant (FLR),FLR growth rate between 2 phase operation,operation time,bleeding volume,postoperative complications,postoperative survival etc.We discussed the detail technology and discuss the surgical procedure combine our experience and the published papers.Results ALPPS was performed successfully in all 3 patients.According to the Cheng's Classification of PVTT,they were classified as type Ⅱ,1 case and Ⅲ type,2 cases.Preoperative liver function was Child-Pugh A grade,average ICG R15 was 7.3％ (4.2％-11.0％),and average FLR was 387 ml (333-484 ml).The mean time interval between 2 phases surgery was 24.7 days (9-50 days) and the average FLR growth rate was 50.3％ (24.4％-82.3％).Morbidity of Clavien-Dindo Ⅲ or more was recorded in 1 case,but no mortality occurred.During follow-up period,2 patients were treated with TACE for tumor recurrence.All patients survived with acceptable life quality till now.The portal vein tumor thrombosis necrosis was observed in all 3 specimens.Conclusions ALPPS is a valuable surgery for effective control of tumor thrombus and radical resection rate in well selected PVVT type Ⅱ and type Ⅲ patients.It is expected to improve the therapeutic effect in combination with TACE and other treatment methods.
出处
《国际外科学杂志》
2017年第4期-,共6页
International Journal of Surgery
基金
国家科技支撑计划(2012BAI06B01)National Science and Technology Infrastructure Program
关键词
联合肝脏分隔和门静脉结扎的二步肝切除术
门静脉癌栓
癌
肝细胞
预留肝体积
肝再生
Association of liver partition and portal vein ligation for staged hepatectomy
Portal vein tumor thrombosis
Carcinoma,hepatocellular
Future liver remnant
Liver regeneration
