ALPPS治疗巨大原发性肝癌患者近远期疗效研究

doi:10.3969/j.issn.1672-5069.2021.02.026

摘要/Abstract

摘要： 目的探讨联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)治疗巨大原发性肝癌(PLC)患者的近远期疗效。方法 2016年1月～2018年2月我院诊治的98例巨大PLC患者,其中20例接受ALPPS治疗(A组),38例在经肝动脉化疗栓塞术( TACE)治疗后手术切除肿瘤(B组),和40例接受直接手术切除肿瘤(C组)。术后,行CT增强扫描,应用IQQA-Liver肝脏CT解读分析系统进行肝脏三维重建,测量全肝体积( TLV)、残余肝脏体积(RLV)、术后3个月肝脏体积(FRLV),计算肝增生体积和肝增生率。结果术后,A组FRLV为(366.3±31.7)mL,显著大于B组【(185.2±16.4)mL或C组(181.9±14.2)mL,P＜0.05】,肝增生率为(68.8±6.4)%,显著高于B组【(21.4±2.0)%或C组(22.6±2.3)%,P＜0.05】; 术后15 d,A组血清白蛋白水平为(37.0±2.7)g/L,显著高于B组【(34.1±2.9)g/L或C组(34.0±3.2)g/L,P＜0.05】;A组2 a总生存率为70.0%,无进展生存率为55.0%,B组分别为55.3%和36.8%,C组分别为52.5%和42.5%,三组之间无显著性差异(P＞0.05)。结论 ALPPS可使巨大PLC患者术后剩余肝脏体积在短时间内迅速增加,加快了患者术后肝功能的恢复。

关键词: 原发性肝癌, 联合肝脏分隔和门静脉结扎的二步肝切除术, 经肝动脉化疗栓塞术, 生存率

Abstract: Objective The purpose of this study was to explore the short-term and long-term survivals of patients with huge primary liver cancer (PLC) after associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) . Methods The clinical data of 98 patients with PLC including in our hospital between January 2016 and February 2018 were retrospectively analyzed, and 20 patients were treated with ALPPS (group A), 38 patients underwent surgical resection after transcatheter hepatic arterial chemoembolization (TACE) (group B), and 40 patients received direct resection of huge liver cancer (group C). The liver regeneration was estimated by post-operational CT scan, and the total liver volume (TLV),the remnant liver volume ( RLV) and future remnant liver volume at three months ( FRLV) were calculated, and the regenerative volume (RV) and the regeneration rate (RR) were obtained.Results At 3 months after surgery, the FRLV in group A was (366.3±31.7)mL, significantly greater than (185.2±16.4)mL in group B or (181.9±14.2)mL in group C (P＜0.05), and the RR was (68.8±6.4)%, significantly higher than (21.4±2.0)% in group B or (22.6±2.3)% in group C (P＜0.05); fifteen days after operation, serum albumin level in group A was (37.0±2.7)g/L, significantly higher than (34.1±2.9)g/L in group B or (34.0±3.2)g/L in group C (P＜0.05); the two-year total survival and the progress-free survival in group A were 70.0% and 55.0%, and they were 55.3% and 36.8% in group B and 52.5% and 42.5% in group C, not significantly different among them (P＞0.05).Conclusion The surgery of ALPPS could rapidly increase the remnant liver volume in a short time after operation, and accelerate the postoperative liver function recovery in patients with PLC, which warrants further investigation.

Key words: Hepatoma, Associated liver partition and portal vein ligation for staged hepatectomy, Transcatheter hepatic arterial chemoembolization, Short-term and long-term survival

莫娟, 闫文, 徐绍强. ALPPS治疗巨大原发性肝癌患者近远期疗效研究[J]. 实用肝脏病杂志, 2021, 24(2): 252-255.

Mo Juan, Yan Wen, Xu Shaoqiang. Short-term and long-termsurvivals of patients with huge primary liver cancer after associated liver partition and portal vein ligation for staged hepatectomy[J]. Journal of Practical Hepatology, 2021, 24(2): 252-255.

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