肝脏离断联合门静脉结扎两步肝切除术治疗复杂肝门部肿瘤

Associating liver partition combined with portal vein ligation for staged hepatectomy： a new hepatectomy for the unresectable hepatic neoplasms

肝脏离断联合患侧门静脉结扎二期肝切除术是一种全新的肝切除术（ALPPS）.我们于2013年8月对1例68岁肝门部胆管细胞癌合并阻塞性黄疸男性患者实施了该手术.因为患者左肝外叶体积不足标准肝体积的40％（只有33.91％）,我们第1步先行右侧门静脉结扎＋原位离断左肝内叶和左肝外叶交界处肝组织以及肝门部淋巴结清扫术.术后第8天复查CT显示左肝外叶肝体积增加了32％,占标准肝体积的41.55％,术后第12天我们再行扩大右三叶切除＋左肝管-空肠内引流术.术后三周痊愈出院.

Associating liver partition and portal vein ligation for two-staged hepatectomy（ALPPS） is a novel approach for hepatectomy.The case we reported was a 68 years old male patient diagnosed with hilar cholangiocellular carcinoma and obstructive jaundice.ALPPS surgery was operated.Since the patient＇s left lateral lobe volume was less than 40% of the whole liver volume （merely 33.91%）,the ligation of the right portal vein,plus in situ split of the junction zone between left medial and left lateral liver lobe and the dissection of portal lymph nodes as the first stage operation was conducted.Abdominal CT on the 8th day after the operation reported an increase on the volume of left lateral lobe by 32% to 41.5% of the whole liver volume.On the 12th day after the first stage operation,an extended right trilobate hepatectomy combined with left hepatic duct intra-jejunum drainage was performed as the second operation.The patient completely recovered and was discharged three weeks after the second stage operation.