以剩余肝体积快速增长决定ALPPS第二步手术实施的经验总结

Strategy on timing of ALPPS stageⅡbased on increase in remnant liver volume

目的探讨以剩余肝体积(FLR)快速增长决定联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)第二步手术施行的安全性与疗效。方法回顾性分析2014年4月至2020年12月香港大学深圳医院行前入路ALPPS的19例肝肿瘤患者资料,其中男性13例,女性6例,平均年龄53岁。第一步手术后1周内FLR/标准肝体积(ESLV)增加超过50%的8例患者纳入快速增长组,剩余的11例患者1周内FLR/ESLV增加未超过50%纳入对照组。比较两组第二步手术时间、第二步术中出血量、第二步手术后住院时间、术后并发症等。结果19例患者均完成第二步肝切除,仅有1例术后死亡。快速增长组第二步手术时间(3.2±1.8)h、第二步术中出血量(554±227)ml、第二步手术后住院时间(12.6±2.4)d,优于对照组(4.7±2.2)h、(760±314)ml、(18.2±6.4)d,差异均有统计学意义(均P<0.05)。两组第一步手术后并发症发生率[37.5%(3/8)比45.4%(5/11)]和第二步手术后并发症发生率[37.5%(3/8)比36.4%(4/11)]比较,差异均无统计学意义(均P>0.05)。结论肝肿瘤患者以FLR快速增长(1周内增加超过50%)决定ALPPS第二步施行是安全可行的,且有利于第二步手术的实施及患者的快速康复。但本结论有待更大样本量研究进一步证实。

Objective To study the safety and efficacy on timing of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)stageⅡbased on increase in remnant liver volume.Methods 19 patients(male:female 13:6;average age 53 years)with liver tumors treated by ALPPS from April 2014 to December 2020 were retrospectively studied.Patients with FLV/ESLV(future liver volume/estimated standard liver volume)increase of more than 50%within 1 week followed by stageⅡALPPS were included into the rapid group(n=8).Those who failed to have 50%increase in FLV/ESLV within 1 week were included into the control group(n=11).The two groups were compared in the ALPPS stage Ⅱ in operating time,blood loss,postoperative complications,mortality rate and hospital stay.Results All 19 patients underwent ALPPS stage Ⅱ uneventfully.One patient in the control group died from liver failure within 30 days of operation.The operation time(3.2±1.8)h,blood loss(554±227)ml and postoperative hospital stay(12.6±2.4)d in the rapid group were significantly better than those in the control group(4.7±2.2)h,[(760±314)ml,(18.2±6.4)d(all P<0.05)].The two groups had similar complication rates in both post stageⅠ[37.5%(3/8)vs.45.4%(5/11)],or stageⅡ[37.5%(3/8)vs.36.4%(4/11)](both P>0.05).Conclusion Rapid increase in FLR volume of more than 50%within a week was safe and feasible to proceed to ALPPS stage II.This conclusion needs to be confirmed by further studies using large sample sizes.