联合肝脏离断和门静脉结扎的二步肝切除治疗结直肠癌肝转移被引量：4

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy-A new Method for the Treatment of Colorectal Liver Metastases(CRLM)

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摘要目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增生后再行右三肝切除.结果第1步手术后7 d,残肝体积从313.5 m L增加到559.1 m L,并在第1步手术后8 d,第2步手术行右三肝切除.第2步手术后8 d患者顺利出院,肝功能恢复基本正常,联合肝脏离断和门静脉结扎的二步肝切除诱导了残肝组织快速的增生.结论联合肝脏离断和门静脉结扎的二步肝切除提高了结直肠癌肝转移患者的可切除率.联合肝脏离断和门静脉结扎的二步肝切除有较高的并发症率和死亡率,因此需要仔细选择手术患者;该术式的可行性、安全性还需要进一步研究评估. Objective To study the technique of associating liver partitioning and portal vein occlusion for staged hepatectomy （ALPPS）, which has been advocated as a novel tool to increase resectability for the patients who have colorectal cancer liver metastases （CRLM） with a small liver remnant. Methods The patients with CRLM underwent ALPPS. In the first stage, the right portal vein branch was ligated and subsequently the liver parenchyma was dissected along the falciform ligament to isolate the segment IV and the left lateral lobe. Results On postoperative day 7, the remnant liver volume was increased from 313.5mL to 559.1mL, and on postoperative day 8, the second stage Right trisectionectomy was successfully performed, the hepatic function was normal. ALPPS induces a great and fast hypertrophy of the remnant live. Conclusions ALPPS has emerged as a new strategy to increase resectability of the CRLM. Due to high morbidity and mortality rates of ALPPS procedure, the surgical candidates should be selected carefully. Moreover, there are oncological outcomes which are very limited available evidence for its technical feasibility, safety and needed for further evaluation in larger scale of studies.

作者张升宁李来邦任刚陈奕明刘滇生刘剑冉江华李立

机构地区昆明医科大学附属甘美医院昆明市第一人民医院肝胆胰一科

出处《昆明医科大学学报》 CAS 2015年第7期84-88,共5页 Journal of Kunming Medical University

基金昆明市科技局重点项目(2012-02-03-A-H-04-0001)

关键词肝切除结直肠癌肝转移肝脏肿瘤 Hepatectomy Colorectal liver metastases （CRLM） Liver neoplasms

分类号 R735.37 [医药卫生—肿瘤]

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