联合肝离断和门静脉结扎两阶段肝切除术在治疗中晚期肝癌中的应用进展
| 作者: |
1路远,
2浦涧
1 右江民族医学院研究生学院，广西 百色 533000) 2 右江民族医学院附属医院肝胆外科/广西肝胆疾病临床研究中心，广西 百色 533000) |
| 通讯: |
浦涧
Email: Pujianym@163.com |
| DOI: | 10.3978/j.issn.2095-6959. 2018.12.029 |
| 基金: | 广西医疗卫生适宜技术开发与推广应用项目(S201653)；广西科技计划项目- 广西肝胆疾病临床医学研究中心课题( 桂科AD17129025)。 |
摘要
肝巨大、复杂性、恶性肿瘤手术的彻底性和安全性一直是国内外学者讨论的话题和研究的方向，如何在能够保证患者安全的前提下，彻底切除肿瘤也一直是每一位肝外科医生所追求的目标。但根治肝癌面临残余肝体积过小而引起肝衰竭的严重问题。因此，巨大原发性肝癌手术方式的研究从未停止，从门静脉栓塞术(portal vein embolization，PVE)到门静脉结扎术(portal vein ligation， PVL)、再到联合肝离断和门静脉结扎两阶段肝切除术(associating liver par tition and por tal vein ligation for staged hepatectomy，ALPPS)术式的出现，不断地推动肝癌治疗的快速发展。由于早期ALPPS手术难度大、风险高、术式操作不成熟，患者术后并发症发生率及病死率均较高。经近6年的探索，ALPPS术后并发症、病死率均不断下降，甚至零死亡，成为当今治疗巨大难切性肝肿瘤的主要术式之一。
关键词：
巨大肝癌；肝离断；门静脉结扎
Application progress of associating liver partition and portal vein ligation for staged hepatectomy in curing mid-advanced liver neoplasms
CorrespondingAuthor: PU Jian Email: Pujianym@163.com
DOI: 10.3978/j.issn.2095-6959. 2018.12.029
Foundation: This work was supported by Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project (S201653) and Guangxi Science and Technology Plan Project-Guangxi Hepatobiliary Disease Clinical Medical Research Center Project (Guike AD17129025), China.
Abstract
The thoroughness and safety of liver surgery, complexity, and malignant tumor surgery have always been the topic of discussion and research direction of scholars at home and abroad. How to completely eradicate tumors under the premise of ensuring patient safety has always been a goal pursued by a liver surgeon. However, the radical nature of liver cancer faces a serious problem of liver failure caused by excessive liver volume. Therefore, the research on the surgical methods of giant primary liver cancer has never stopped, and the emergence of Portal vein embolization (PVE) to Portal vein ligation (PVL) and then Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has continuously promoted the rapid development of liver cancer treatment. In the early stage of ALPPS, due to its difficult operation, high risk, and immature operation, the incidence of complications and mortality after surgery were high. After nearly 6-year continuous exploration, ALPPS postoperative complications and mortality have been declining, even reaching zero death, which becomes one of the main surgical treatments for the treatment of huge and difficult liver tumors.
Keywords：
huge liver cancer; liver partition; portal vein ligation