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

Laparoscopic-assisted associating liver partition and portal vein ligation for staged hepatectomy for primary liver cancer

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。

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 hepatoeellular 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 laparoscopie ligation of the right branch of the portal vein and liver partition. Seven days later, open right hepatic trisegmenteetomy 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 hepatoeellular carcinoma and insufficient volume of the future liver remnant.