联合肝脏离断和门静脉结扎分期肝切除术后再发腹腔肿物1例MDT讨论

MDT discussion of a case of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy

目的总结联合肝脏离断和门静脉结扎分期肝切除术(ALPPS)后再发腹腔肿物的诊治经验。方法对2019年9月广西医科大学第一附属医院(简称“我院”)肝胆外科收治的1例肝细胞癌施行ALPPS术后1年再发腹腔肿物患者的临床病理资料进行回顾性分析。结果1例40岁男性患者因“ALPPS术后1年腹痛、腹胀5 d”入院后发现腹腔肿物且对肿物性质不明确,经我院多学科协作团队(MDT)会诊后拟行剖腹探查腹腔肿物切除。术后切除部分肿物壁送术中冰冻病理检查提示慢性炎症,在手术进程中见阑尾周围脓肿形成考虑化脓性阑尾炎穿孔引起腹膜后脓肿,遂切除阑尾并将肿物壁送术中冰冻病理检查证实为化脓性阑尾炎穿孔并腹膜后脓肿形成。术后加强抗感染、对症支持治疗后痊愈出院。该患者术后随访至今,一般情况好,未见临床复发。结论对于ALPPS术后患者注意定期随访,若发现腹腔肿物且对肿物性质不明确时应积极行MDT讨论,以制定更加合理的治疗方案,在排除禁忌证后仍应积极手术治疗,可使患者最大程度获益。

Objective To summarize experiences of diagnosis and treatment of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in treatment of hepatocellular carcinoma(HCC).Method The clinicopathologic data of a 40 years old case of HCC with intraperitoneal mass after ALPPS in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.Results The patient was admitted to this hospital because of abdominal pain and abdominal distension for 5 d.The intraperitoneal mass was found and its nature was not clear on year 1 after ALPPS on admission.After discussion of multidisciplinary team(MDT),the exploratory laparotomy and abdominal tumor resection were planned to perform.The intraperitoneal mass and appendix were removed,the resected tissues were diagnosed as chronic inflammation and retroperitoneal abscess caused by perforation of suppurative appendicitis,respectively.The anti-infection and symptomatic support treatment were strengthened to perform after operation,the patient discharged after recovery.The patient was followed up so far,the general condition was good,and there was no clinical recurrence.Conclusions For patient underwent ALPPS,regular follow-up should be paid attention to.If intraperitoneal mass is found and nature is not clear,MDT discussion should be performed so as to make a more reasonable treatment plan.After exclusion of contraindications,surgical treatment should be carried out to furthest benefit patients.