联合肝脏离断和门静脉结扎的分阶段肝切除术治疗肝细胞癌

Associating liver partition and portal vein ligation for staged hepatectomy in treatment of hepatocellular carcinoma

目的探讨联合肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)治疗肝细胞癌(肝癌)的安全性及有效性。方法回顾性分析2014年9月至2014年11月在中山大学附属第三医院接受ALPPS治疗的2例肝癌患者临床资料。2例患者均签署知情同意书,符合医学伦理学规定。例1男,46岁,体重(BW)51 kg,AFP>2 000μg/L,肝功能Child-Pugh分级A级。腹部CT示肝Ⅶ/Ⅷ段巨块型肝癌,11 cm×10 cm。未来剩余肝脏体积(FRLV)378 ml,估计的标准肝脏体积(ESLV)915 ml,FRLV/ESLV 41%,未来剩余肝脏重量(FRLW)318 g,FRLV/BW 0.62%。例2男,30岁,BW 53 kg,AFP 42 326μg/L,肝功能Child-Pugh分级A级。腹部CT示肝中叶巨块型肝癌,11 cm×11 cm。FRLV/ESLV 31%,FRLW/BW 0.45%。第1次手术,分离结扎门静脉右支,沿镰状韧带右侧分割肝左外叶。2例患者分别于第1次术后28、14 d行肝右三叶切除术。结果例1第1次术后17 d FRLV为504 ml,较术前增长33%,FRLV/ESLV由术前41%提高至55%,FRLW/BW由术前0.62%提高至0.81%。例2第1次术后7 d FRLV为574 ml,较术前增长100%,FRLV/ESLV由术前31%提高至53%,FRLW/BW由术前0.45%提高至0.91%。例1和例2分别于第2次术后45、24 d顺利出院。结论 ALPPS为FRLV不足的肝癌患者提供新的治疗选择。

Objective To investigate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） in the treatment of hepatocellular carcinoma （HCC）. Methods Clinical data of 2 patients with HCC who underwent ALPPS in the Third Affiliated Hospital of Sun Yat-sen University between September 2014 and November 2014 were retrospectively analyzed. The informed consents of 2 patients were obtained and the local ethical committee approval was received. Case 1 was a 46-year-old male with the body weight （BW） of 51 kg, AFP〉2 000 μg/L, and the liver function was graded as Child-Pugh class A. Abdominal CT scan revealed a massive HCC of 11 cm × 10 cm in size in the Ⅶ/Ⅷ liver segments. The future remnant liver volume （FRLV） was 378 ml. The estimated standard liver volume （ESLV） was 915 ml. The FRLV/ESLV ratio was 41%. The future remnant liver weight （FRLW） was 318 g. The FRLV/BW ratio was 0.62%. Case 2 was a 30-year-old male with the BW of 53 kg, AFP 42 326 p.g/L, and the liver function was graded as Child-Pugh class A. Abdominal CT scan revealed a massive HCC of 11 cm × 11 cm in size in the middle liver segment. The FRLV/ESLV ratio was 31% and the FRLW/BW ratio was 0.45%. During the first operation, the right branch of portal vein was separated and ligated. The left liver lobe was partitioned along with the right falciform ligament. Two patients underwent right hepatic trisectionectomy at 28, 14 d after the first operation. Results The FRLV of case 1 was 504 ml at 17 d after the first operation, and increased 33% compared with preoperative FRLV. The FRLV/ESLV increased from 41% of preoperation to 55%. The FRLW/BW increased from 0.62% ofpreoperation to 0.81%. The FRLV of case 2 was 574 ml at 7 d after the first operation, and increased 100% compared with preoperative FRLV. The FRLV/ESLV increased from 31% of preoperation to 53%. The FRLW/BW increased from 0.45% of preoperation to 0.91%. Case 1 and 2 were successfully discharged at postoperative 45 and 24 d. Conclusions ALPPS offers a novel option for the treatment of HCC patients with insufficient FRLV.