联合肝脏离断和门静脉结扎的二步肝切除术治疗肝硬化巨大肝癌2例报告并文献复习

目的:探讨联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)治疗肝硬化巨大肝癌的安全性及有效性。方法:回顾性分析2014年8月和2015年1月东南大学附属中大医院行ALPPS治疗的2例合并肝硬化的右肝巨大肝癌患者的临床资料,通过围手术期指标和术后随访资料评价疗效。结果:2例患者第一步手术行门静脉右支结扎和左右半肝原位劈离,第一步手术后2例患者的剩余肝体积均迅速增大,患者1术后6 d,剩余肝体积达到704.8 m L,占标准肝体积的60.3%;患者2术后11 d,剩余肝体积达到771.3 m L,占标准肝体积的63.6%。2例患者第二步手术行扩大右半肝切除术。第一步手术时间分别为240 min和210 min,术中出血均为600 m L;第二步手术时间为300 min和325 min,术中出血为1000 m L和800 m L。围手术期无死亡及术后严重并发症发生。术后随访6个月,均无新发肝内外转移。结论:ALPPS治疗肝硬化巨大肝癌是安全可行的。

Associating liver partition and portal vein ligation for staged hepatectomy in treatment of massive liver cancer with cirrhosis: a report of 2 cases and literature review

Objective: To investigate the feasibility and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treatment of massive hepatocellular carcinoma with cirrhosis. Methods: The clinical data of two patients with massive right lobe primary hepatocellular carcinoma and concomitant cirrhosis undergoing ALPPS in Affiliated Zhongda Hospital of Southeast University in August 2014 and January 2015 respectively were retrospectively analyzed. The treatment efficacy was assessed by using perioperative variables and follow-up data.Results: Both patients underwent first-stage surgical procedures of right portal vein ligation and in situ partitioning of the liver parenchyma. The remnant liver volume was rapidly increased in both of them after the first-stage operation, which in case 1 increased to 704.8 mL (accounted for 60.3% of the standard liver volume) at postoperative day (POD) 6, and in case 2 increased to 771.3 mL (accounted for 63.6% of the standard liver volume) at POD 11. Both patients then underwent second-stage extended right hemihepatectomy. The operative time for the first-stage procedure was 240 min and 210 min respectively, with intraoperative blood loss of 600 mL in each case; the operative time for the second-stage procedures was 300 min and 325 min, with intraoperative blood losses of 1 000 mL and 800 mL, respectively. No perioperative death or serious postoperative complications occurred in either patient, and both patients were alive and no new intra- or extra-hepatic recurrence was observed in either of them during 6-month follow-up period. Conclusion: ALPPS is safe and feasible for massive liver cancer with cirrhosis.