腹腔镜一期开腹二期ALPPS治疗巨块型肝癌的疗效分析

发布时间：2018-04-04 15:01

本文选题：癌　切入点：肝细胞　出处：《中国普通外科杂志》2017年08期

【摘要】：目的:探讨腹腔镜一期开腹二期ALPPS(联合肝脏离断和门静脉结扎二步肝切除术)治疗巨块期肝癌的可行性及有效性。方法:回顾性分析2014年4月—2016年4月12例巨块型肝癌(直径10 cm)合并肝硬化患者行腹腔镜一期开腹二期ALPPS的临床资料。结果:治疗前,患者肝功能均为Child B级、平均ICGR_(15)为(23.4±1.5)%、计算剩余肝体积(FLR)为(308±64)mL,占全肝体积比为(27±3.8)%。一期手术中,除1例中转开腹外其他均成功实施全腹腔镜手术;一期手术后,所有患者的肝功能均转为Child A级,ICGR_(15)为(8.6±4.2)%、FLR体积为(684±129)mL,占全肝体积比为(56±7.7)%。两次手术的平均间隔时间为10.5(7~16)d。二期开腹手术中,7例为扩大右半肝切除术,5例为右三肝切除术,术中平均失血量650(200~1 200)mL,术中平均输血量为3.5(1.5~6)U。术后无严重并发症,腹水与一过性胆汁漏经保守治疗后痊愈,无围手术期死亡。术后随访6~30个月,3例死亡,其余生存。结论:腹腔镜一期开腹二期ALPPS是巨块型肝癌安全、有效的方法。
[Abstract]:Objective: to investigate the feasibility and efficacy of laparoscopic one stage open stage ALPPS (combined hepatic dissection and portal vein ligation two step hepatectomy) in the treatment of giant hepatocellular carcinoma (HCC).Methods: the clinical data of 12 patients with massive hepatocellular carcinoma (10 cm in diameter) complicated with cirrhosis by laparoscopy were retrospectively analyzed from April 2014 to April 2016.Results: before treatment, the liver function of all the patients was Child B grade, the average ICGRSTL was 23.4 卤1.5g / L, and the calculated residual liver volume was 308 卤64mL, with a ratio of 27 卤3.8mL to the whole liver volume.The average interval between the two operations was 10.5 days.In the second stage operation, 7 cases were enlarged right hemihepatectomy and 5 cases were right third hepatectomy. The average blood loss during operation was 650 ~ 200 ~ 1 200 mL, and the average blood transfusion volume was 3.5 ~ 1.5 ~ 6 渭 m 路L ~ (-1) ~ (-1) 路L ~ (-1) ~ (-1) 路L ~ (-1) ~ (-1) ~ (-1).No serious postoperative complications, ascites and temporary bile leakage after conservative treatment, no perioperative death.3 cases died and the rest survived after 6 ~ 30 months follow-up.Conclusion: Laparoscopic one-stage open-stage ALPPS is a safe and effective method for massive hepatocellular carcinoma.
【作者单位】：中南大学湘雅二医院肝胆外科;
【分类号】：R735.7

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