腹腔镜辅助联合肝脏离断和门静脉结扎的二步肝切除术治疗原发性肝癌的安全性和疗效评价

目的探讨腹腔镜辅助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 ）治疗原发性肝癌的安全性和疗效。方法回顾性分析2013年12月本院收治的一例巨块型肝癌患者以腹腔镜辅助ALPPS方法切除肿瘤的临床资料。第1步在腹腔镜下结扎门静脉右支并离断左肝内外叶；第2步在第1次术后第8天，评估剩余肝脏体积能满足机体要求后行右半肝的扩大切除术，同时对患者围术期的临床指标和随访资料进行分析。结果第1次手术出血50 ml，手术时长225分钟。第2次手术出血700 ml，手术时长335分钟。切除右肝三叶大小约24．0 cm×22．0 cm×15．0 cm，重量2．7 kg，肿瘤大小约18．0 cm×16．0 cm×14．0 cm，残余肝大小约15．0 cm×13．0 cm×8．0 cm。术后病理结果为原发性肝细胞癌。术后患者出现胆漏，经保守治疗后治愈。术后随访2个月，残余肝再生体积达约1200 ml，AFP降至150 ng／ml，未发现肿瘤复发转移。术后随访至32个月，再次评估残余肝再生体积达约1300 ml，AFP 16 ng／ml，未发现肿瘤复发转移，无疾病生存期达32个月。结论腹腔镜辅助ALPPS手术可作为残肝体积不足的一些较晚期肝癌患者的治疗选择。

Safety and efficacy evaluation of Laparoscopic-assisted associating liver partition and portal vein ligation for staged hepatectomy for primary liver cancer

Objective To evaluate the safety and efficacy of laparoscopic-assisted associating liver partition and portal vein ligation for staged hepatectomy for primary liver cancer. Methods In this article, the initial experience with 1 case of hepatocellular carcinoma who underwent laparoscopic-assisted ALPPS in December 2013 was reported. Laparoscopic guided right portal vein ligated was firstly performed;subsequently the liver parenchyma was dissected along the falciform ligament to isolate the segment Ⅳ and the left lateral lobe. Seven days later,The residual liver volume satisfied the basic requirement. Open right hepatic trisegmentectomy was performed as the second-stage surgery. The clinical and follow-up data of this patient during perioperative period were analyzed. Results The amount of bleeding was 50 ml, and the operative time was 225 minutes for the first-stage surgery. The amount of bleeding was 700 ml , and the operative time was 335 minutes for the second-stage surgery. The excision right hepatic lobe size was 24.0 cm×22.0 cm×15.0 cm. the tumor size was about 18.0 cm×16.0 cm×14.0 cm, which weighted 2.7 kg. The residual liver volume was 15.0 cm×13.0 cm×8.0 cm. The postoperative pathology was primary hepatocellular carcinoma. Bile leakage happened after operation, which was cured by conservative treatment. After two months follow-up, the residual liver regeneration volume was about 1200 ml. AFP declined to 150 ng/ml.Tumor recurrence and metastasis were not found. After fifty-two months follow-up , the residual liver regeneration volume was about 1300 ml. AFP was 16 ng/ml. We had never found any tumor recurrence and metastasis. The disease free survival of the patient was thirty-two months. Conclusions Laparoscopic associated ALPPS is an excellent choice for patients with giant hepatocellular carcinoma and insufficient volume of the future liver remnant.