腹腔镜下肝脏离断、门静脉结扎肝切除术治疗巨大肝癌的效果

The effect of laparoscopic liver partition and portal vein ligation in hepatectomy for huge liver cancer

目的:分析巨大肝癌患者施行腹腔镜辅助联合肝脏离断、门静脉结扎二步肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)的临床效果,为临床治疗提供参考。方法:2013年3月至2015年2月收治的5例巨大肝癌患者作为研究对象,均采取腹腔镜辅助二步肝切除术,分析围手术期指标变化,并测定肝功能。结果:第1步手术后予以常规血浆、抗生素及保肝等对症治疗,术后7 d剩余肝脏体积估计为606 ml,剩余肝脏质量体重比为0.81%,术后监测指标显示腹腔引流量逐渐减少,白细胞、丙氨酸氨基转移酶逐渐恢复正常,直接胆红素、总胆红素均在正常范围。第2步术后腹腔引流液逐渐减少,术后7 d,白细胞、丙氨酸氨基转移酶恢复正常,巨大肝癌质量(3.4±0.5)kg,病理报道为中分化肝细胞癌,肉眼可见肝脏硬化表现,术后约10 d出院。结论:巨大肝癌行腹腔镜辅助ALPPS治疗效果良好,术后肝功能恢复正常,为治疗提供了新的选择。

Objective： To analyze the clinical effect of laparoscopic associating liver partition and portal vein ligation for staged hepatectomy（ ALPPS）,and provide reference for clinical treatment. Methods： Five patients with huge liver cancer from Mar. 2013 to Feb. 2015 were selected,patients underwent laparoscopic assisted ALPPS,perioperative changes and liver function indicators were measured. Results： After the first surgery,patients were given symptomatic treatment such as routine plasma,antibiotics and liver protection,after 7 d remaining liver volume estimated was 606 ml,ratio of remnant liver mass to body weight was 0. 81%,postoperative monitoring indicators showed that peritoneal drainage volume gradually decreased,white blood cells and alanine aminotransferase gradually returned to normal,DBIL and TBIL were in the normal range. After step 2 operations,volume of abdominal drainage gradually reduced,after 7 d,white blood cell and alanine aminotransferase returned to normal. The mass of liver huge cancer was（ 3. 4 ± 0. 5） kg,pathology was reported as moderately differentiated hepatocellular carcinoma,cirrhosis of the liver was found,patients were discharged in 10 d after surgery. Conclusions： Laparoscopic assisted ALPPS in the treatment of huge liver cancer is effective,postoperative liver function could return to normal,this procedure provides an alternative for treatment.