联合肝脏离断和门静脉结扎二步肝切除术临床应用研究(附2例报告)

Associating liver partition and portal vein ligation for staged hepatectomy:A report of 2 cases

目的探讨联合肝脏离断和门静脉结扎二步肝切除术(ALPPS)治疗进展期肝脏恶性肿瘤的可行性及安全性。方法回顾性分析2012年7月至2012年10月北京大学肿瘤医院行ALPPS的2例病人的临床资料,通过围手术期指标和随访资料评价疗效。结果 2例病人第1步手术时间分别360、300 min,术中出血分别500、400 mL,第2步手术时间分别为270、330min,术中出血分别为600、400mL,无围手术期死亡及术后严重并发症发生。第1步手术后第28天剩余肝脏体积分别较术前增大67.7%及66.7%。2例病人术后随访时间分别为16个月和15个月,均无新发肝转移。结论 ALPPS为剩余肝脏体积不足的进展期肝脏恶性肿瘤提供了新的治疗选择。

Objective To investigate the feasibilities and safeties of associating liver partition and portal vein ligation for staged hepatectomy（ALPPS）in the treatment of advanced hepatic malignancies. Methods The clinical data of 2 cases of advanced hepatic malignancies which underwent ALPPS between July 2012 and October 2012 at Peking University Cancer Hospital were analyzed retrospectively. The perioperative indicators and follow-up data were evaluated. Results Both patients underwent major hepatectomies without mortality and severe complications. In the first-stage surgeries,the operative time was 360 min and 300 min respectively. Moreover the intraoperative blood loss was 500 mL and 400 mL respectively. In the second-stage surgeries,the operative time was 270 min and 330 min respectively. Moreover the intraoperative blood loss was 600 mL and 400 mL respectively. Comparing to the preoperative remnant liver volume（RLV）,the RLV increased 67.7% and 66.7% respectively in 28 days. After 16 months and 15 months follow-up,both patients were alive without relapse. Conclusion ALPPS extended the indication of ALPPS and is a new choice for the patients of advanced hepatic malignancies without sufficient RLV.