CAJ | 학술논문

目的：讨论联合肝脏离断和门静脉结扎的二步肝切除术（associating liver partition and portal vien ligation for staged hepatectomy，ALPPS）治疗巨大肝癌的可行性、安全性和临床价值。方法收治1例巨大肝癌患者并行ALPPS，回顾分析其临床资料并复习文献。结果术前评估患者未来剩余肝脏体积约占标准肝体积的21.06%。患者一期手术行右侧门静脉结扎和左、右半肝原位劈离；一期手术术后7 d，剩余肝脏体积达标准肝体积的48.84%，第13天二期手术行右半肝切除术。术后患者未出现严重肝功能衰竭，但围手术期出现胸腔积液和腹水等并发症，经治疗后顺利出院。术后2个月随访，未见复发、转移，AFP降至正常范围。结论 ALPPS为残肝体积过小的肝肿瘤患者接受根治性切除术提供了一种新方法，但ALPPS并发症和死亡率均较高，采取该术式应慎重。
목적：토론연합간장리단화문정맥결찰적이보간절제술（associating liver partition and portal vien ligation for staged hepatectomy，ALPPS）치료거대간암적가행성、안전성화림상개치。방법수치1례거대간암환자병행ALPPS，회고분석기림상자료병복습문헌。결과술전평고환자미래잉여간장체적약점표준간체적적21.06%。환자일기수술행우측문정맥결찰화좌、우반간원위벽리；일기수술술후7 d，잉여간장체적체표준간체적적48.84%，제13천이기수술행우반간절제술。술후환자미출현엄중간공능쇠갈，단위수술기출현흉강적액화복수등병발증，경치료후순리출원。술후2개월수방，미견복발、전이，AFP강지정상범위。결론 ALPPS위잔간체적과소적간종류환자접수근치성절제술제공료일충신방법，단ALPPS병발증화사망솔균교고，채취해술식응신중。
Objective To investigate the safety and efficacy of associating liver partition and portal vien ligation for staged hepatectomy (ALPPS)for the treatment of huge hepatocellular carcinoma (HCC). Methods A patient with huge HCC was admitted in June 2014 to the Affiliated Tumor Hospital of Guangxi Medical University and underwent ALPPS. The clinicopathological characteristics and operative outcomes of this patient were compared with the ALPPS literature. Results Preoperative assessment showed a ratio of future liver remnant to standard liver volume of 21.06%. The patient underwent a first-stage operation involving right portal vein ligation and in situ splitting of the liver parenchyma. At 7 d after this operation,the ratio of future liver remnant to standard liver volume was 48.84%. At 13 d after the first operation,the patient underwent a second-stage operation involving right hemihepatectomy. The patient experienced perioperative pleural effusion and ascites,and was discharged without severe postoperative liver failure. During 2-month follow-up, no metastasis or recurrence occurred,and AFP levels remained within the normal range. Conclusion ALPPS may be a new treatment option for patients with liver neoplasm whose future liver remnant volume is too small to allow radical resection. ALPPS is associated with high morbidity and mortality,suggesting the need for careful patient selection.