联合肝脏离断和门静脉结扎的二步肝切除术的可行性、安全性评价

发布时间：2018-03-22 21:17

本文选题：癌　切入点：肝细胞　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:联合肝脏离断和门静脉结扎的二步肝切除术(Associating liver partition and portal vein ligation,ALPPS)旨在预防肝大部切除术后残肝体积不足而导致的急性肝功能衰竭。通过对肝细胞肝癌合并肝硬化病例实施ALPPS手术的临床资料回顾性分析,探讨这一手术方式在巨块型肝癌合并肝硬化病例中的可行性和安全性。方法:回顾分析2014年9月至2016年10月,北京协和医院肝脏外科收治的共9例巨块型肝癌合并肝硬化行ALPPS手术病例。分析第二步手术完成率、残肝体积(future liver remnant,FLR)增长率、死亡率。系统检索ALPPS对比传统二步肝切除术的相关文献,从符合标准的文献中提取第二步手术完成率、手术并发症、死亡率、FLR增长率等指标,进行Meta分析。结果:全部9例病例均完成两步手术且未发生严重并发症;无术后死亡病例。通过Meta分析发现ALPPS病例术后FLR增长明显高于门静脉栓塞和门静脉结扎的二步肝切除术病例,两者比较有统计学差异(42.2%;95%CI 26.52-57.87,P0.001;47.65%;95%CI 29.43-65.88%,P0.001);手术并发症发生率及术后死亡率与门静脉栓塞和门静脉结扎的二步肝切除术病例比较无统计学差异(27.7%;OR 0.723,95%CI 0.258-2.207,P = 0.537;44.7%;OR 0.553,95%CI 0.158-1.938,P = 0.371),(35.6%;OR 0.644,95%CI 0.166-2.499,P = 0.524;42.9%;OR 0.571,95%CI 0.07-4.683,P = 0.602)。结论:ALPPS技术对于残肝体积不足的巨块型肝癌合并肝硬化的病例安全、可行,为这类患者增加了手术治疗的机会。对比传统二步肝切除术,ALPPS能获得更快残肝体积增长,第二步手术完成率更高,且未增加手术并发症发生率及术后死亡率。
[Abstract]:Objective: to prevent acute hepatic failure caused by hepatic remnant insufficiency after partial hepatectomy with portal vein ligation combined with two-step hepatectomy with associated liver partition and portal vein ligation (ALPPSs). Clinical data of patients undergoing ALPPS operation were retrospectively analyzed. Objective: to investigate the feasibility and safety of this procedure in patients with massive liver cancer complicated with cirrhosis. Methods: from September 2014 to October 2016, a retrospective analysis was made. A total of 9 patients with giant liver cancer complicated with cirrhosis underwent ALPPS operation in the Department of liver surgery, Peking Union Hospital. The rate of completion of the second step operation and the growth rate of residual liver volume in future liver liver were analyzed. The mortality rate, operative complications, mortality rate, mortality rate and mortality rate of ALPPS were extracted from the standard documents. The mortality rate of ALPPS was higher than that of traditional two-step hepatectomy. The mortality rate of ALPPS was compared with that of traditional two-step hepatectomy. Meta analysis was performed. Results: all 9 cases underwent two-step operation without serious complications. Meta analysis showed that the increase of FLR in ALPPS patients was significantly higher than that in two-step hepatectomy patients with portal vein embolism and portal vein ligation. There was no significant difference in the incidence of postoperative complications and mortality with portal vein embolism and portal vein ligation in two-step hepatectomy cases. There was no statistical difference in 27.7OR 0.72395CI 0.258-2.207P = 0.53737 / 44.7CI 0.55395CI 0.158-1.9338 P = 0.37195 / 0.64495CI 0.166-2.4999P = 0.5242.995 / 0.571.95 / 95 / 0.55395CI 0.158-1.938 P = 0.371/ 0.64495CI 0.166-2.4999P = 0.5242.995 / 0.57.1. Conclusion\\\% ALPPS technique is safe for patients with massive hepatocellular carcinoma with insufficient residual liver volume and liver cirrhosis, P = 0. 07-4. 683 (P = 0. 602). Compared with traditional two-step hepatectomy, ALPPS can obtain faster residual liver volume growth, higher completion rate of the second step operation, and no increase in the incidence of complications and postoperative mortality.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R657.31

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