腹腔镜辅助联合肝脏离断和门静脉结扎二步肝切除术治疗原发性肝癌可行性研究

曹 君,张红卫,张 磊,商昌珍,黄泽坚,罗 璇,陈亚进

中国实用外科杂志 ›› 2014, Vol. 34 ›› Issue (01) : 77-80.

中国实用外科杂志 ›› 2014, Vol. 34 ›› Issue (01) : 77-80.
论著

腹腔镜辅助联合肝脏离断和门静脉结扎二步肝切除术治疗原发性肝癌可行性研究

  • 曹    君,张红卫,张    磊,商昌珍,黄泽坚,罗    璇,陈亚进
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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步肝切除术(ALPPS)治疗较晚期巨大肝癌的安全性与微创性。回顾性分析2013年8月中山大学孙逸仙纪念医院收治的1例右肝巨块型原发性肝癌并右肝内多发转移病人行腹腔镜辅助ALPPS的临床资料。方法    第1步行腹腔镜下门静脉右支结扎+肝实质离断术,术后第7天行第2步开腹肝脏右三叶切除术,并对围手术期指标进行分析。结果    第1步手术时间205 min,第2步手术时间160 min。第1步手术后6 d病人肝功能恢复正常,左外叶体积较术前增加115.9%,随后安全进行第2步开腹肝脏右三叶切除术,第2步手术后第8天肝功能恢复正常。结论    腹腔镜辅助ALPPS为残肝体积不足的较晚期巨大肝癌病人提供了一个良好的治疗选择。

Abstract

Laparoscopic-assisted associating liver partition and portal vein ligation for staged hepatectomy for primary liver cancer        CAO Jun,ZHANG Hong-wei,ZHANG Lei,et al. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
Corresponding  author:CHEN Ya-jin, E-mail:cyj0509@126.com
Abstract    Objective    Our aim was to investigate the feasibility of laparoscopic “Associating liver partition and portal vein ligation for staged hepatectomy” (ALPPS) in the treatment of advanced hepatocellular carcinoma. We retrospectively analyzed the clinical data of one patient with a huge right-lobe hepatocellular carcinoma  lesion and multiple right-lobe metastases who underwent laparoscopic ALPPS in the Sun Yat-sen Memorial Hospital in August 2013. Methods    The first-stage surgery was laparoscopic ligation of the right branch of the portal vein and liver partition. Seven days later, open right hepatic trisegmentectomy was performed as the second-stage surgery. The perioperative indicators were then analyzed.  Results    The operative time was 205 minutes for the first-stage surgery and 160 minutes for the second-stage surgery. Liver function returned to normal six days after the first-stage surgery and left lateral lobe volume increased 115.9% compared to the preoperative volume. The second-stage open right hepatic trisegmentectomy was then performed safely and liver function returned to normal eight days after the second-stage surgery. Conclusion   Laparoscopic ALPPS is an excellent choice for patients with advanced hepatocellular carcinoma and insufficient volume of the future liver remnant.

关键词

腹腔镜 / 原发性肝癌 / 剩余肝脏体积

Key words

laparoscopy / primary liver cancer / remnant liver volume

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曹 君,张红卫,张 磊,商昌珍,黄泽坚,罗 璇,陈亚进. 腹腔镜辅助联合肝脏离断和门静脉结扎二步肝切除术治疗原发性肝癌可行性研究[J]. 中国实用外科杂志. 2014, 34(01): 77-80

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