完全腹腔镜ALPPS治疗伴有肝硬化的原发性肝癌

Total Laparoscopic ALPPS for Primary Liver Cancer Complicated with Cirrhosis

目的探讨腹腔镜ALPPS治疗伴肝硬化的原发性肝癌的可行性及效果。方法回顾性分析2015年7月我院采用完全腹腔镜ALPPS治疗的1例伴肝硬化的原发性肝癌患者的临床资料,一期行门静脉右支结扎+肝实质离断术,7 d后行二期腹腔镜下扩大右半肝切除术。结果一期手术时间120 min,出血量100 ml,术后肝功能自第1 d起即开始好转,术后第6 d复查CT剩余肝体积(FLR)达:507 ml,标准肝体积(SLV):1 240 ml,FLR/SLV为40.1%,残肝增长39.67%;二期手术时间120 min,出血量150 ml,术后肝功能基本正常。结论全腹腔镜ALPPS治疗伴有肝硬化的原发性肝癌是可行的,术后肝脏能短期内代偿增生。腹腔镜下ALPPS能有效减少两次手术给患者带来的巨大创伤,促进术后恢复,并且术后早期的活动能减少术后并发症发生。

Objective To investigate the feasibility, efficacy and safety of total laparoscopic associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） in the treatment of primary liver cancer complicated with cirrhosis. Methods The clinical data of one primary liver cancer patient with cirrhosis trea- ted by total laparoscopic ALPPS in Hunan provincial people＇s hospital in July 2015 was analyzed retrospectively. The first-stage surgery was the liver parenchyma splitting in situ and right portal vein ligation under laparoscope, and the second-stage surgery was laparoscopic complete tumor removal and extended right hemihepatectomy. Results In the first-stage operation, the operative duration was 120 minutes, the intraoperative blood loss was 100 ml, and the liver function was improved. The future liver remnant （FLR） was 507 ml, the standard liver volume （SLV） was 1 240 ml, the FLR/SLV was 40.1% in 6 days later, and the residual liver was increased 39.67% than that of preoperative volume. In the second-stage operation, the operative time was 120 minutes, the intraoperative blood loss was 150 ml, and the liver function was nearly normal. Conclusion The total laparoscopic ALPPS is a feasible surgical procedure for primary liver cancer complicated with cirrhosis with the advantages of mini-invasion, fast recovery and fewer complications, and it also can results in a marked and rap- id hypertrophy of the future liver remnant.