中国实用外科杂志

中国实用外科杂志

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腹腔镜辅助联合肝脏离断和门静脉结扎的二期肝切除术治疗伴有轻-中度肝硬化的原发性肝细胞癌（附7例报告）

黄泽坚，曹    君，李闻达，商昌珍，张    磊，张红卫，陈亚进   

  1. 中山大学孙逸仙纪念医院肝胆胰外科，广东广州510120
  • 出版日期:2016-01-01 发布日期:2015-12-31

  • Online:2016-01-01 Published:2015-12-31

摘要：

目的     分析腹腔镜辅助联合肝脏离断和门静脉结扎的二期肝切除术（ALPPS）治疗伴有轻-中度肝硬化的较晚期巨大肝癌的安全性、有效性和微创性。方法    回顾性分析2013年8月至2014年10月中山大学孙逸仙纪念医院行腹腔镜辅助下ALPPS治疗伴有轻-中度肝硬化巨大原发性右肝肝癌7例的临床资料。第1期行腹腔镜下门静脉右支结扎＋肝实质离断术，待未来剩余肝脏体积（FLR）增生后行第2期开腹肝脏右三叶切除术，并对围手术期结果和近期肿瘤学疗效进行分析。结果    7例均行全腹腔镜下的第1期肝脏离断和门静脉结扎术，其中4例FLR扩增达标，行第2期开腹肝脏右三叶切除术。第1期平均手术时间（192.9±35.9）min，第2期平均手术时间（210.0±73.9）min，平均FLR增生率35.6%，围手术期无严重并发症及死亡发生。术后随访1年，平均至肿瘤复发时间为178.7 d。结论    在有经验的肝胆外科中心对选择性病人实施腹腔镜辅助ALPPS是可行的，对轻度肝硬化以下的原发性肝细胞癌病人实施腹腔镜下门静脉右支结扎和肝脏离断能有效刺激FLR明显扩增，并具有相对较低的并发症发生率和病死率，围手术期相对安全，为FLR不足的较晚期巨大肝癌病人提供了一个治疗选择。

关键词: 腹腔镜, 原发性肝细胞癌, 肝硬化, 联合肝脏离断和门静脉结扎的二期肝切除术, 剩余肝脏体积

Abstract:

Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for advanced hepatocellular carcinoma with cirrhosis：A  report of 7 cases        HUANG Ze-jian , CAO Jun,  LI Wen-da Li, et al.Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital,Sun Yat-sen University, Guangzhou 510120, China
HUANG Ze-jian and CAO Jun contributed equally to this work
Corresponding author:  CHEN Ya-jin ,E-mail：cyj0509@126.com
Abstract    Objective    Our aim was to investigate the feasibility and oncological efficacy of laparoscopic “Associating liver partition and portal vein ligation for staged hepatectomy” (ALPPS) in the treatment of advanced hepatocellular carcinoma with cirrhosis. Methods    We retrospectively analyzed the clinical data of 7 patients with a huge right-lobe hepatocellular carcinoma lesion who underwent laparoscopic ALPPS in the Sun Yat-sen Memorial Hospital from August 2013 to October 2014. The first-stage surgery was laparoscopic ligation of the right branch of the portal vein and liver partition. When the future liver remnant (FLR) increased, open right hepatic trisegmentectomy was performed as the second-stage surgery. The perioperative indicators and early oncological efficacy were then analyzed.  Results    The operative time was 192.9±35.9min for the first-stage surgery and 210±73.9min for the second-stage surgery. The future liver remnant volume increased 35.6%, on average, compared to the preoperative volume, The rate of liver failure and mortality were 42.9% and 14.3%,.The tumor recurrence rates were 25% and 75% at 90 days and 1 year post-operation. The average time to tumor recurrence was 178.7days. Conclusion    Laparoscopic ALPPS is an additional choice for patients with advanced hepatocellular carcinoma and insufficient volume of the future liver remnant.

Key words: laparoscopy, primary liver cancer, cirrhosis, associating liver partition and portal vein ligation for staged hepatectomy, remnant liver volume