全腹腔镜ALPPS治疗肝脏恶性肿瘤(附三例报告及文献复习)

目的探讨全腹腔镜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 for staged hepatectomy,ALPPS)治疗肝脏恶性肿瘤的治疗选择。方法回顾性分析2019年中国科学技术大学附属第一医院肝脏外科行全腹腔镜ALPPS治疗的1例直肠癌术后肝脏多发转移和2例巨块型肝癌的临床资料,分析围手术期检查指标和术后随访结果以评价该术式的临床应用价值。结果第一步手术均在腹腔镜下行门静脉右支结扎和原位肝实质离断+胆囊切除术,第一次和第二次术前三维可视化结果显示,3例病例术前两次预估剩余肝脏体积分别为221 ml和364 ml,320 ml和532 ml以及332 ml和422 ml,预留肝脏体积较前增加了65%、66%和27%,在剩余肝脏体积比达到安全标准后第二步手术行解剖性右三叶肝切除术,术后对症治疗肝功能逐渐恢复,围手术期无死亡及其他严重并发症,随访至今未见肿瘤复发、无远处转移。结论全腹腔镜下可以安全地、有效地开展ALPPS,预留肝脏短期内能代偿增生。腹腔镜ALPPS为复杂的肝脏恶性肿瘤创造了手术切除的可能性。

Totally laparoscopic ALPPS in the treatment of hepatic malignancies:a report of 3 cases and literature review

Objective To investigate the treatment options of totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for liver malignancies.Methods The clinical data of 1 case of liver multiple metastases after resection of rectal cancer and 2 cases of massive hepatocellular carcinoma who had been successfully performed a laparoscopic ALPPS in 2019 in the Department of Hepatic Surgery,The First Affiliated Hospital of USTC were analyzed retrospectively.The perioperative examination index and postoperative follow-up results were analyzed to evaluate the clinical application value of the procedure.Results The results of the first and second preoperative three-dimensional visualization showed that the estimated residual liver volume was 221 ml and 364 ml,320 ml and 532 ml and 332 ml and 422 ml,respectively,and the reserved liver volume increased by 65%,66%and 27%,respectively,in the three cases.After the residual liver volume ratio reached the safety standard,the second step of anatomical right trefoil hepatectomy was performed.The liver function was gradually recovered after postoperative symptomatic treatment.There was no death or other serious complications during the perioperative period.No tumor recurrence or distant metastasis was observed during follow-up to date.Conclusion ALPPS can be performed safely and effectively under laparoscopy,and the liver can be compensated for hyperplasia in the short term.Laparoscopic ALPPS provides the possibility of surgical resection for complex liver malignancies.