联合肝脏分割和门静脉结扎的二步肝切除术术后早期复发原因的分析

文章编号] 1673-9701（2019）16-0021-05

[Abstract] Objective To retrospectively analyze the causes of early recurrence after associating liver partition and portal vein ligation for staged hepatectomy （ALPSS）. Methods 12 patients treated with ALPPS or radiofrequency ablation assisted ALPPS（RALPPS） during June 2014 to June 2016 were included. Liver function， Child-Pugh score， lesion， degree of liver segmentation， postoperative disease-free survival time， and overall survival time of patients were retrospectively analyzed. Results After ALPPS stage-1， the FLR volume increased from （333.7±54.1） mL to （577.1±83.7） mL， and the difference was statistically significant（P<0.001）. The interval between stage-1 and stage-2 was（10.0±1.6） days for complete ALPPS and （31.3±5.2） days for partial ALPPS， and the difference was statistically significant （P<0.001）. The mortality rate within 90 days after surgery was 0%（0/12）， and the Clavien-Dindo complications were graded as Ⅰ-Ⅲa. The recurrence rates within 3， 6， and 12 months after surgery were 16.7% （2/12）， 83.3% （10/12）， and 100.0% （12/12） respectively;the mean DFS time was （4.5±0.6） months， and the mean survival time was （9.0±0.7） months， and the median follow-up time was 11.0 months. Conclusion Patients with ALPPS and RALPPS are prone to early recurrence. Surgical trauma， overlong FLR regeneration time after partial ALPPS， incomplete segmentation of liver parenchyma， and incomplete ablation of tumor cells may be the causes of early postoperative recurrence.

[Key words] Portal vein embolization; Staged hepatectomy; Future liver remnant; Tumor recurrence; ALPPS

大量肝切除术后未来残余肝脏（FLR）体积不足可引起术后肝功能衰竭（post-hepatectomy liver failure，PHLF）[1]。与门静脉栓塞术（portal vein occlusion， PVO）相比，联合肝脏分割和门静脉结扎的二步肝切除术（ALPPS）可更快地促进FLR再生并提高手术切除率[2-4]，然而其肿瘤学预后却常被忽视。2014年6月～2016年6月，我科共有12例患者接受了ALPPS手术，回顾性分析显示所有患者术后出现早期复发。本文拟分析导致ALPPS术后早期复发的一些可能原因，并为改进该手术方式提供思路和参考，现报道如下。

推荐访问:门静脉 结扎 术后 肝脏 复发

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