联合肝脏分割和门静脉结扎的分阶段肝切除术治疗直肠癌肝转移一例

The clinical analysis of associating liver partition and portal vein ligation for staged hepatectomy in patient with liver metastasis of rectal cancer： a case report

我院采用联合肝脏分割和门静脉结扎分阶段肝切除术（ALPPS）治疗1例直肠癌多发肝转移患者.本文报道该病临床诊治经验,特别是ALPPS的手术方式及术后近期效果.患者2014年5月入院.术前三维重建评估行扩大右半肝切除术后剩余肝脏体积占标准肝体积的23.11％.采用开腹ALPPS方案,第1步手术后12天再次计算剩余肝脏体积占标准肝体积的34.8％.于第1步手术后13天行第2步手术.患者术后并发大量腹水,予以充分引流及补充白蛋白后痊愈.1个月后复查未见复发.ALPPS治疗CRLM患者安全可行,近期手术效果良好.

This article mainly presented the clinical experience of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） in one patient with liver metastasis of rectal cancer.The patient was admitted in Tianjin Medical University Cancer Institute and Hospital with colo-rectal liver metastasis （CRLM） in May 2014.The surgical approach and post-operative outcomes were mainly introduced.Preoperative 3-D reconstruction confirmed that the ratio of the remnant liver volume to the standard liver volume was 23.11％ after extended right hepatectomy.Totally open ALPPS was applied.Twelve days post the first operation,the ratio of the remnant liver volume to the standard liver volume was 34.8％.The second resection was carried out 13 days after the first stage of operation.The patient was complicated with massive ascites and was cured by fully drainage and complement of albumin.No recurrence were observed.Experience from this case indicates that totally open ALPPS is safe and feasible to patients with CRLM.The short-term efficacy is satisfying.