【摘要】 目的用射频消融术代替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)中的肝脏离断(RALPPS),观察其在治疗合并肝硬化的原发性肝癌患者的效果。方法对8例预留剩余肝体积(FLR)不足(<40%)合并有肝硬化的原发性肝癌患者施行RALPPS,观察其围手术期相关指标(并发症、死亡率、手术时间、出血量、FLR变化情况及两期手术间隔时间)。结果 8例患者实施RALPPS手术后6例完成了二期手术,2例因术后并发症或肿瘤转移未完成二期手术。一期手术时间为(214.3±35.7)min,出血量为(218.8±113.2)m L;二期手术时间为(266.7±46.0)min及出血量为(501.7±224.5)m L。术前FLR百分比为(26.4±7.1)%,二期手术前FLR百分比为(46.2±4.6)%,增长率为35%~113%。两期手术间隔时间为(22.2±6.4)d。1例因二期手术后并发肾功能衰竭及严重肺部感染死亡;7例患者获随访(11.6±2.0)个月(8~15个月)。2例未完成二期手术者于出院后3个月内死亡。完成二期手术者中3例出院后3~9个月肿瘤复发,辅以介入治疗,其中1例死亡;2例随访至今无复发。结论 RALPPS治疗FLR不足合并肝硬化的原发性肝癌患者可以达到ALPPS同样的效果。更多还原

【Abstract】 Objective To evaluate whether radiofrequency-assisted associating liver partition and portal vein ligation for staged hepatectomy(RALPPS) is a safer and more effective modified treatment for patients with cirrhosisrelated hepatocellular carcinoma(HCC).Methods RALPPS were performed in patients with HCC and insufficient volume of future liver remnant(FLR<40%).Data of the patients during perioperative period such as operative morbidity,mortality,operative time,blood loss,percent increase in FLR,and interval between operations,were analyzed to assess the effectiveness and safety of the operation.Results A total of 8 patients were performed the RALPPS operation,and 6cases completed both stages,2 cases of postoperative complications or tumor metastasis did not complete the two phase of surgery.The average first and second stages operative time was(214.3±35.7) min,(266.7±46.0) min,respectively,and the average two stages blood loss during the operation was(218.8±113.2) mL,(501.7± 224.5) ml,respectively.The mean preoperative FLR was(26.4±7.1)%,and the mean FLR before the second stage was(46.2±4.6)%.The average percentage increase in FLR during the interval time was 35%—113%,and the mean time interval between operations were(22.2 ± 6.4)days.One case died of renal failure and severe pulmonary infection after two operation.Seven patients were followed-up(11.6+2.0) months(8-15 months).Two patients who had not completed the two-stage operation died within 3 months after discharge.Three patients who had completed the two-stage operation were tumor recurrence in 3-9 months after discharged from hospital and supplemented interventional therapy,1 of them died,and 2 patients were followed-up to now without recurrence.Conclusions RALPPS is equivalent to ALPPS for treating patients with cirrhosis-related HCC and insufficient FLR volume.更多还原