全腹腔镜下ALPPS同期行结肠癌根治术治疗结肠癌肝转移

Total laparoscopic ALPPS and simultaneous radical resection of colon cancer for patients with colorectal liver metastases

目的探讨全腹腔镜下联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)同期行结肠癌根治术治疗结肠癌肝转移的可行性和疗效。方法回顾性分析2015年8月兰州大学第一医院收治的1例乙状结肠癌伴肝转移患者临床资料。患者男,51岁。患者签署知情同意书,符合医学伦理学规定。第一期行腹腔镜下结肠癌根治术+门静脉右支结扎+原位肝脏劈离术。第二期行腹腔镜下扩大右半肝切除+肝转移灶局部切除术,并对围手术期指标进行分析。结果两期手术均在腹腔镜下顺利完成。第一期手术时间350 min,术中出血量450 ml。术后3周,剩余肝脏体积占全肝体积39%,遂行第二期手术。术后肝功能恢复顺利。结论对于结肠癌伴肝转移患者,ALPPS两期手术均能在腹腔镜下安全实施,ALPPS手术同期切除结肠癌原发灶是合理、安全的。

Objective To investigate the feasibility and efficacy of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） and simultaneous radical resection of colon cancer in treating patients with colorectal liver metastases. Methods Clinical data of 1 patient with sigmoid colon cancer and liver metastases treated in the First Affiliated Hospital of Lanzhou University in August 2015 were analyzed retrospectively. The patient was male, 51 years old. The informed consent was obtained and the local ethical committee approval was received. In the first stage of operation, laparoscopic radical resection of colon cancer, ligation of right branch of portal vein, and in situ liver splitting were performed. In the second stage, laparoscopic extended right hemihepatectomy and local resection of liver metastases were performed. The perioperative parameters of this patient were analyzed. Results Operations of two stages were completed successfully under total laparoscope. The operation time of first stage was 350 rain, and intraoperative bleeding was 450 ml. Three weeks after operation, the remnant liver volume to total liver volume was 39%, then the second stage operation was performed. Liver function of the patient recovered well after operation. Conclusions For patients with colorectal liver metastases, two stage operations of ALPPS can be performed safely under laparoscope. ALPPS and simultaneous resection of primary colon cancer is reasonable and safe.