门静脉和肝动脉结扎序贯二步法肝切除术治疗巨大肝癌

Selective ligation of portal vein and hepatic vein combined with sequential hepatectomy for the treatment of giant liver cancer

巨大肝癌切除术后剩余肝脏体积不足是发生肝衰竭的主要原因.通过阻断一侧的门静脉和肝动脉,使肿瘤降低分期,增加对侧术后剩余肝脏体积,成为目前切除巨大肝癌的方法之一.2013年3-4月厦门大学附属第一医院收治的1例原发性右半肝巨大肝癌患者,因肝脏剩余体积不足,术者一期行选择性门静脉及肝动脉结扎术后,序贯二期行肝切除术.患者2次手术均顺利完成,一期行门静脉右支及肝右动脉结扎术,术后肝肿瘤体积缩小,剩余左半肝代偿性增生良好,肝脏体积由术前488 mL增加到术后1个月689 mL.一期手术后33 d顺利实施二期巨大肝癌肝切除术,2次术后均无严重并发症发生.术后随访2个月,患者剩余肝脏未见肿瘤复发,AFP由术前425 mg/L降至26×10^-3mg/L.因此,选择性门静脉及肝动脉结扎后序贯二步法肝切除术可能是传统手术无法切除的巨大肝癌患者有效的治疗方法.

Inadequate volume of the remnant liver after hepatectomy for giant liver cancer is the main cause of hepatic failure. Blocking the portal vein and hepatic artery of one side, degrade the stage of the tumor, and increase the contralateral postoperative residual liver volume became one of the methods for the treatment of giant liver cancer. A patient with giant right liver cancer was admitted to the First Affiliated Hospital of Xiamen University on March 22, 2013. Because of the inadequate volume of remnant liver, the portal vein and hepatic vein were selectively ligated, and then followed by hepatectomy. The size of the tumor was decreased after ligation of the portal vein and hepatic artery, and the volume of the remnant left liver was increased from 488 mL to 689 mL at the first months after the operation. The duration between the first and second surgeries was 33 days. No severe complications were detected after the surgeries. The patient was followed up for 2 months, tumorrecurrence did not detected in the remnant left liver, and the level of alpha-fetoprotein was decreased from preoperative 425 mg/L to post-operative 26 ×10^-3 mg/L. Selective ligation of portal vein and hepatic artery combined with sequential hepatectomy might be an effective treatment method for giant liver cancer.