完全腹腔镜下行ALPPS治疗伴肝硬化的原发性肝癌可行性临床探讨

Totally laparoscopic ALPPS for primary liver cancer complicated with cirrhosis——application of round-the-liver ligation to replace parenchymal transection

目的分析完全腹腔镜下行联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)治疗伴有肝硬化的原发性肝癌的可行性、有效性和安全性,并介绍利用绕肝止血带取代肝实质离断的经验。方法回顾性分析2014年5月浙江大学医学院附属邵逸夫医院收治的1例左肝伴肝硬化的原发性肝癌病人临床资料。第一期行腹腔镜下门静脉左支结扎+绕肝止血带安置术。第二期于术后第11天行腹腔镜左半肝切除术,并对围手术期指标进行分析。结果第一期手术时间290 min,第二期手术时间160 min。第一期手术后第3天病人肝功能开始恢复,右叶体积较术前增加94.8%,随后安全进行第二期手术,术后肝功能逐渐恢复。结论 ALPPS两期手术都能在腹腔镜下安全实施;对伴有肝硬化的原发性肝癌,ALPPS同样能够促使未来剩余肝脏的体积在短期内迅速增大;使用绕肝止血带可以取代肝实质离断,效果相似而并发症大为减少。

Objective To study the feasibility,effectiveness and safety of totally laparoscopic ALPPS in treating primary liver cancer complicated with cirrhosis and to introduce the experience of using round-the-liver ligation to replace parenchymal transection.Methods Retrospectively analyze the clinical data of a patient with a left-lobe liver cancer who underwent totally laparoscopic ALPPS in the Sir Run Run Shaw Hospital in May 2014.The first-stage surgery was laparoscopic ligation of the left branch of portal vein and execution of round-the-liver ligature.11 days later laparoscopic left lobectomy was carried out as the second-stage surgery.The perioperative indicators were then analyzed.Results The operation time was 290 minutes for the first-stage surgery and 160 minutes for the second-stage surgery.Liver function returned to normal 3 days after the first-stage surgery and right lobe volume increased 94.8% compared to the preoperative volume.The second-stage laparoscopic left lobectomy was then performed uneventfully and liver function gradually returned to normal after the second-stage surgery.Conclusion Both two stage operations can be safely performed laprarscopically.ALPPS also can Results in a marked and rapid hypertrophy of future remnant even in liver cancer complicated with cirrhosis.Round-the-liver ligature can replace liver parenchymal transection to reduce complications with similar therapeutic results.