联合肝脏离断和门静脉结扎二步肝切除术治疗巨大原发性肝细胞癌1例报告并文献复习

Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of huge primary hepatocellular carcinoma: A report of 1 case and review of literatures

目的探讨联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)治疗巨大原发性肝细胞癌的安全性及有效性。方法回顾性分析2014年12月哈尔滨医科大学附属第一医院行ALPPS的1例右肝巨大肝细胞癌并门静脉三个分支病人的临床资料,第一步手术结扎门静脉右支并原位劈离肝左外叶和左内叶,第二步行肝脏右三叶切除术。结果第一步手术7 d后,剩余肝脏体积由术前281 m L增加至606 m L,术后第7天肝功能恢复正常。第一步术后第8天行第二步手术,术后第5天肝功恢复正常。结论 ALPPS为残余肝脏体积不足的巨大肝癌病人提供了新的治疗选择。

Objective To investigate the efficacy and safety of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） in the treatment of huge primary hepatoeellular carcinoma. Methods The clinical data of one case of huge right-lobe primary hepatocellular carcinoma and portal vein of three branches who had been successfully performed an ALPPS in December 2014 in the First Affiliated Hospital of Harbin Medical University was analyzed retrospectively. In the first stage, two branches of the right portal vein branch were ligated and subsequently the liver parenchyma was dissected along the falciform ligament to isolate the segment IV and the left lateral lobe in the first stage. In the second stage, the extended right lobe was removed. Results On the seventh day after the first stage, the remnant liver volume increased from 281mL to 606mL and liver function was returned to normal on the seventh day. On the eighth day after the first stage, the second staged operation was performed and liver function was returned to normal on the fifth day. Conclusion ALPPS brings a new choice for patients with huge hepatocellular carcinoma with insufficient future liver remnant.