腹腔镜辅助与开腹ALPPS治疗肝癌的近期疗效比较
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摘要
目的:探讨比较腹腔镜辅助与开腹联合肝脏离断和门静脉结扎二步肝切除术(ALPPS)对治疗原发性肝癌的近期临床效果,并对其安全性及有效性进行分析。方法:回顾性分析2014年12月—2018年9月在中南大学湘雅医院治疗的27例行ALPPS的原发性肝癌患者临床资料,其中16例一期行腹腔镜手术(腔镜组),11例一期行开腹手术(开腹组),两组二期均为开腹手术。比较两组患者的手术时间、术中出血量、术后排气时间、两期手术间隔时间及术中术后相关并发症情况。结果:腔镜组患者的一期及二期手术时间、术中出血量及术后排气时间、两期手术间隔时间优于开腹组(均P<0.05);腔镜组无术中输血,开腹组术中输血1例;腔镜组的并发症总发生率为12.5%,开腹组患者的并发症总发生率为18.2%,差异无统计学意义(P>0.05)。结论:腹腔镜辅助ALPPS一期手术具有诸多优点,包括出血少,术后排气快,两期手术间隔及手术时间短等,对于合适的肝癌患者,腹腔镜辅助ALPPS一期手术有推广价值。
引文
[1]Lang H,Baumgart J,Mittler J.Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases:Current Scenario[J].Dig Surg,2018,35(4):294-302.doi:10.1159/000488097.
[2]Wicherts DA,de Haas RJ,Adam R.Bringing unresectable liver disease to resection with curative intent[J].Eur J Surg Oncol,2007,33(Suppl 2):S42-51.doi:10.1016/j.ejso.2007.09.017.
[3]Folprecht G,Grothey A,Alberts S,et al.Neoadjuvant treatment of unresectable colorectal liver metastases:correlation between tumour response and resection rates[J].Ann Oncol,2005,16(8):1311-1319doi:10.1093/annonc/mdi246.
[4]Adam R,Wicherts DA,de Haas RJ,et al.Patients with initially unresectable colorectal liver metastases:is there a possibility of cure?[J].J Clin Oncol,2009,27(11):1829-1835.doi:10.1200/JCO.2008.19.9273.
[5]Clavien PA,Petrowsky H,DeOliveira ML,et al.Strategies for safer liver surgery and partial liver transplantation[J].N Engl J Med,2007,356(15):1545-1559.doi:10.1056/NEJMra065156.
[6]Neumann UP,Seehofer D,Neuhaus P.The surgical treatment of hepatic metastases in colorectal carcinoma[J].Dtsch Arztebl Int,2010,107(19):335-342.doi:10.3238/arztebl.2010.0335.
[7]Sotiropoulos GC,Kouraklis G.The ALPPS procedure for extended indications in liver surgery:an old finding applied in surgical oncology[J].Ann Surg,2013,257(6):e26.doi:10.1097/SLA.0b013e3182942e4a.
[8]Schnitzbauer AA,Lang SA,Goessmann H,et al.Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J].Ann Surg,2012,255(3):405-414.doi:10.1097/SLA.0b013e31824856f5.
[9]Li J,Girotti P,K鰊igsrainer I,et al.ALPPS in right trisectionectomy:a safe procedure to avoid postoperative liver failure?[J].J Gastrointest Surg,2013,17(5):956-961.doi:10.1007/s11605-012-2132-y.
[10]Olthof PB,Schadde E,van Lienden KP,et al.Hepatic parenchymal transection increases liver volume but not function after portal vein embolization in rabbits[J].Surgery,2017,162(4):732-741.doi:10.1016/j.surg.2016.12.014.
[11]Abulkhir A,Limongelli P,Healey AJ,et al.Preoperative portal vein embolization for major liver resection:a meta-analysis[J].Ann Surg,2008,247(1):49-57.doi:10.1097/SLA.0b013e31815f6e5b.
[12]El-Serag HB,Marrero JA,Rudolph L,et al.Diagnosis and treatment of hepatocellular carcinoma[J].Gastroenterology,2008,134(6):1752-1763.doi:10.1053/j.gastro.2008.02.090.
[13]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.doi:10.3760/cma.j.issn.1673-9752.2017.07.001.Bureau of Medical Administration,National Health and Family Planning Comission of the People's Republic of China.Standardization of diagnosis and treatment for hepatocellular carcinoma(2017 edition)[J].Chinese Journal of Digestive Surgery,2017,16(7):635-647.doi:10.3760/cma.j.issn.1673-9752.2017.07.001.
[14]Olthof PB,Schnitzbauer AA,Schadde E.The HPB controversy of the decade:2007-2017-Ten years of ALPPS[J].Eur J Surg Oncol,2018,44(10):1624-1627.doi:10.1016/j.ejso.2018.06.005.
[15]刘伟伟,刘洪,余锋,等.联合肝脏分割和门静脉结扎二步肝切除术大鼠模型的建立[J].中国普通外科杂志,2017,26(1):50-56.doi:10.3978/j.issn.1005-6947.2017.01.009.Liu WW,Liu H,Yu F,et al.Establishment of rat model of associating liver partition and portal vein ligation for staged hepatectomy[J].Chinese Journal of General Surgery,2017,26(1):50-56.doi:10.3978/j.issn.1005-6947.2017.01.009.
[16]周俭,王征,孙健,等.联合肝脏离断和门静脉结扎的二步肝切除术[J].中华消化外科杂志,2013,12(7):485-489.doi:10.3760/cma.j.issn.1673-9752.2013.07.002.Zhou J,Wang Z,Sun J,et al.Associating liver partition and portal vien ligation for staged hepatectomy[J].Chinese Journal of Digestive Surgery,2013,12(7):485-489.doi:doi:10.3760/cma.j.issn.1673-9752.2013.07.002.
[17]王志明,陶一明,黄云,等.联合肝脏离断和门静脉切断二步肝切除术在肝炎后肝硬化肝癌中的应用[J].中国普通外科杂志,2014,23(7):867-872.doi:10.7659/j.issn.1005-6947.2014.07.001.Wang ZM,Tao YM,Huang Y,et al.Associating liver partition and portal vein ligation for staged hepatectomy procedure in treatment of hepatocellular carcinoma with post-hepatitic cirrhosis[J].Chinese Journal of General Surgery,2014,23(7):867-872.doi:10.7659/j.issn.1005-6947.2014.07.001.
[18]王志明,胡宽,苌群刚,等.绕肝提拉法在联合肝脏离断和门静脉切断二步肝切除术中的应用[J].中国普通外科杂志,2015,24(1):12-17.doi:10.3978/j.issn.1005-6947.2015.01.003.Wang ZM,Hu K,Chang QG,et al.Application of liver hanging maneuver in associating liver partition and portal vein ligation for staged hepatectomy[J].Chinese Journal of General Surgery,2015,24(1):12-17.doi:10.3978/j.issn.1005-6947.2015.01.003.
[19]Agrawal S,Belghiti J.Oncologic resection for malignant tumors of the liver[J].Ann Surg,2011,253(4):656-665.doi:10.1097/sla.0b013e3181fc08ca.
[20]刘允怡,刘晓欣.对“联合肝脏离断和门静脉结扎的二步肝切除术”的述评[J].中华消化外科杂志,2013,12(7):481-484.doi:10.3760/cma.j.issn.1673-9752.2013.07.001.Liu YY,Liu XX.Comments on Associating liver partition and portal vein ligation for staged hepatectomy[J].Chinese Journal of Digestive Surgery,2013,12(7):481-484.doi:10.3760/cma.j.issn.1673-9752.2013.07.001.
[21]Rahbari NN,Mehrabi A,Mollberg NM,et al.Hepatocellular carcinoma:current management and perspectives for the future[J].Ann Surg,2011,253(3):453-469.doi:10.1097/SLA.0b013e31820d944f.
[22]de Santiba馿s E,Clavien PA.Playing Play-Doh to prevent postoperative liver failure:the"ALPPS"approach[J].Ann Surg,2012,255(3):415-417.doi:10.1097/SLA.0b013e318248577d.
[23]戴卫东,胡继雄,苗雄鹰,等.腹腔镜一期开腹二期ALPPS治疗巨块型肝癌的疗效分析[J].中国普通外科杂志,2017,26(8):1042-1048.doi:10.3978/j.issn.1005-6947.2017.08.013.Dai WD,Hu JX,Miao XY,et al.Efficacy of laparoscopic first stage and open second stage ALPPS for huge hepatocellular carcinoma[J].Chinese Journal of General Surgery,2017,26(8):1042-1048.doi:10.3978/j.issn.1005-6947.2017.08.013.
[24]Donati M,Basile F,Oldhafer KJ.Laparoscopic step 1 ALPPSwith microwave transection of the liver for Klatskin tumors:Is it worthwhile?[J].Hepatobiliary Pancreat Dis Int,2018,17(3):278-279.doi:10.1016/j.hbpd.2018.05.002.
[25]Cai X.Laparoscopic liver resection:the current status and the future[J].Hepatobiliary Surg Nutr,2018,7(2):98-104.doi:10.21037/hbsn.2018.02.07.
[26]Pekolj J,Alvarez F A,Biagiola D,et al.Totally Laparoscopic Mini-ALPPS Using a Novel Approach of Laparoscopic-Assisted Transmesenteric Portal Vein Embolization[J].J Laparoendosc Adv Surg Tech A,2018,28(10):1229-1233.doi:10.1089/lap.2018.0039.
[27]Machado MA,Makdissi FF,Surjan RC,et al.Transition from open to laparoscopic ALPPS for patients with very small FLR:the initial experience[J].HPB(Oxford),2017,19(1):59-66.doi:10.1016/j.hpb.2016.10.004.
[28]Alvarez FA,Ardiles V,Sanchez CR,et al.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS):tips and tricks[J].J Gastrointest Surg,2013,17(4):814-821.doi:10.1007/s11605-012-2092-2.
[29]Tashiro S.Mechanism of liver regeneration after liver resection and portal vein embolization(ligation)is different?[J].J Hepatobiliary Pancreat Surg,2009,16(3):292-299.doi:10.1007/s00534-009-0058-x.
[30]Sala S,Ardiles V,Ulla M,et al.Our initial experience with ALPPStechnique:encouraging results[J].Updates Surg,2012,64(3):167-172.doi:10.1007/s13304-012-0175-y.
[31]Gall TM,Sodergren MH,Frampton AE,et al.Radio-frequencyassisted Liver Partition with Portal vein ligation(RALPP)for liver regeneration[J].Ann Surg,2015,261(2):e45-46.doi:10.1097/SLA.0000000000000607.
[2]Wicherts DA,de Haas RJ,Adam R.Bringing unresectable liver disease to resection with curative intent[J].Eur J Surg Oncol,2007,33(Suppl 2):S42-51.doi:10.1016/j.ejso.2007.09.017.
[3]Folprecht G,Grothey A,Alberts S,et al.Neoadjuvant treatment of unresectable colorectal liver metastases:correlation between tumour response and resection rates[J].Ann Oncol,2005,16(8):1311-1319doi:10.1093/annonc/mdi246.
[4]Adam R,Wicherts DA,de Haas RJ,et al.Patients with initially unresectable colorectal liver metastases:is there a possibility of cure?[J].J Clin Oncol,2009,27(11):1829-1835.doi:10.1200/JCO.2008.19.9273.
[5]Clavien PA,Petrowsky H,DeOliveira ML,et al.Strategies for safer liver surgery and partial liver transplantation[J].N Engl J Med,2007,356(15):1545-1559.doi:10.1056/NEJMra065156.
[6]Neumann UP,Seehofer D,Neuhaus P.The surgical treatment of hepatic metastases in colorectal carcinoma[J].Dtsch Arztebl Int,2010,107(19):335-342.doi:10.3238/arztebl.2010.0335.
[7]Sotiropoulos GC,Kouraklis G.The ALPPS procedure for extended indications in liver surgery:an old finding applied in surgical oncology[J].Ann Surg,2013,257(6):e26.doi:10.1097/SLA.0b013e3182942e4a.
[8]Schnitzbauer AA,Lang SA,Goessmann H,et al.Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J].Ann Surg,2012,255(3):405-414.doi:10.1097/SLA.0b013e31824856f5.
[9]Li J,Girotti P,K鰊igsrainer I,et al.ALPPS in right trisectionectomy:a safe procedure to avoid postoperative liver failure?[J].J Gastrointest Surg,2013,17(5):956-961.doi:10.1007/s11605-012-2132-y.
[10]Olthof PB,Schadde E,van Lienden KP,et al.Hepatic parenchymal transection increases liver volume but not function after portal vein embolization in rabbits[J].Surgery,2017,162(4):732-741.doi:10.1016/j.surg.2016.12.014.
[11]Abulkhir A,Limongelli P,Healey AJ,et al.Preoperative portal vein embolization for major liver resection:a meta-analysis[J].Ann Surg,2008,247(1):49-57.doi:10.1097/SLA.0b013e31815f6e5b.
[12]El-Serag HB,Marrero JA,Rudolph L,et al.Diagnosis and treatment of hepatocellular carcinoma[J].Gastroenterology,2008,134(6):1752-1763.doi:10.1053/j.gastro.2008.02.090.
[13]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.doi:10.3760/cma.j.issn.1673-9752.2017.07.001.Bureau of Medical Administration,National Health and Family Planning Comission of the People's Republic of China.Standardization of diagnosis and treatment for hepatocellular carcinoma(2017 edition)[J].Chinese Journal of Digestive Surgery,2017,16(7):635-647.doi:10.3760/cma.j.issn.1673-9752.2017.07.001.
[14]Olthof PB,Schnitzbauer AA,Schadde E.The HPB controversy of the decade:2007-2017-Ten years of ALPPS[J].Eur J Surg Oncol,2018,44(10):1624-1627.doi:10.1016/j.ejso.2018.06.005.
[15]刘伟伟,刘洪,余锋,等.联合肝脏分割和门静脉结扎二步肝切除术大鼠模型的建立[J].中国普通外科杂志,2017,26(1):50-56.doi:10.3978/j.issn.1005-6947.2017.01.009.Liu WW,Liu H,Yu F,et al.Establishment of rat model of associating liver partition and portal vein ligation for staged hepatectomy[J].Chinese Journal of General Surgery,2017,26(1):50-56.doi:10.3978/j.issn.1005-6947.2017.01.009.
[16]周俭,王征,孙健,等.联合肝脏离断和门静脉结扎的二步肝切除术[J].中华消化外科杂志,2013,12(7):485-489.doi:10.3760/cma.j.issn.1673-9752.2013.07.002.Zhou J,Wang Z,Sun J,et al.Associating liver partition and portal vien ligation for staged hepatectomy[J].Chinese Journal of Digestive Surgery,2013,12(7):485-489.doi:doi:10.3760/cma.j.issn.1673-9752.2013.07.002.
[17]王志明,陶一明,黄云,等.联合肝脏离断和门静脉切断二步肝切除术在肝炎后肝硬化肝癌中的应用[J].中国普通外科杂志,2014,23(7):867-872.doi:10.7659/j.issn.1005-6947.2014.07.001.Wang ZM,Tao YM,Huang Y,et al.Associating liver partition and portal vein ligation for staged hepatectomy procedure in treatment of hepatocellular carcinoma with post-hepatitic cirrhosis[J].Chinese Journal of General Surgery,2014,23(7):867-872.doi:10.7659/j.issn.1005-6947.2014.07.001.
[18]王志明,胡宽,苌群刚,等.绕肝提拉法在联合肝脏离断和门静脉切断二步肝切除术中的应用[J].中国普通外科杂志,2015,24(1):12-17.doi:10.3978/j.issn.1005-6947.2015.01.003.Wang ZM,Hu K,Chang QG,et al.Application of liver hanging maneuver in associating liver partition and portal vein ligation for staged hepatectomy[J].Chinese Journal of General Surgery,2015,24(1):12-17.doi:10.3978/j.issn.1005-6947.2015.01.003.
[19]Agrawal S,Belghiti J.Oncologic resection for malignant tumors of the liver[J].Ann Surg,2011,253(4):656-665.doi:10.1097/sla.0b013e3181fc08ca.
[20]刘允怡,刘晓欣.对“联合肝脏离断和门静脉结扎的二步肝切除术”的述评[J].中华消化外科杂志,2013,12(7):481-484.doi:10.3760/cma.j.issn.1673-9752.2013.07.001.Liu YY,Liu XX.Comments on Associating liver partition and portal vein ligation for staged hepatectomy[J].Chinese Journal of Digestive Surgery,2013,12(7):481-484.doi:10.3760/cma.j.issn.1673-9752.2013.07.001.
[21]Rahbari NN,Mehrabi A,Mollberg NM,et al.Hepatocellular carcinoma:current management and perspectives for the future[J].Ann Surg,2011,253(3):453-469.doi:10.1097/SLA.0b013e31820d944f.
[22]de Santiba馿s E,Clavien PA.Playing Play-Doh to prevent postoperative liver failure:the"ALPPS"approach[J].Ann Surg,2012,255(3):415-417.doi:10.1097/SLA.0b013e318248577d.
[23]戴卫东,胡继雄,苗雄鹰,等.腹腔镜一期开腹二期ALPPS治疗巨块型肝癌的疗效分析[J].中国普通外科杂志,2017,26(8):1042-1048.doi:10.3978/j.issn.1005-6947.2017.08.013.Dai WD,Hu JX,Miao XY,et al.Efficacy of laparoscopic first stage and open second stage ALPPS for huge hepatocellular carcinoma[J].Chinese Journal of General Surgery,2017,26(8):1042-1048.doi:10.3978/j.issn.1005-6947.2017.08.013.
[24]Donati M,Basile F,Oldhafer KJ.Laparoscopic step 1 ALPPSwith microwave transection of the liver for Klatskin tumors:Is it worthwhile?[J].Hepatobiliary Pancreat Dis Int,2018,17(3):278-279.doi:10.1016/j.hbpd.2018.05.002.
[25]Cai X.Laparoscopic liver resection:the current status and the future[J].Hepatobiliary Surg Nutr,2018,7(2):98-104.doi:10.21037/hbsn.2018.02.07.
[26]Pekolj J,Alvarez F A,Biagiola D,et al.Totally Laparoscopic Mini-ALPPS Using a Novel Approach of Laparoscopic-Assisted Transmesenteric Portal Vein Embolization[J].J Laparoendosc Adv Surg Tech A,2018,28(10):1229-1233.doi:10.1089/lap.2018.0039.
[27]Machado MA,Makdissi FF,Surjan RC,et al.Transition from open to laparoscopic ALPPS for patients with very small FLR:the initial experience[J].HPB(Oxford),2017,19(1):59-66.doi:10.1016/j.hpb.2016.10.004.
[28]Alvarez FA,Ardiles V,Sanchez CR,et al.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS):tips and tricks[J].J Gastrointest Surg,2013,17(4):814-821.doi:10.1007/s11605-012-2092-2.
[29]Tashiro S.Mechanism of liver regeneration after liver resection and portal vein embolization(ligation)is different?[J].J Hepatobiliary Pancreat Surg,2009,16(3):292-299.doi:10.1007/s00534-009-0058-x.
[30]Sala S,Ardiles V,Ulla M,et al.Our initial experience with ALPPStechnique:encouraging results[J].Updates Surg,2012,64(3):167-172.doi:10.1007/s13304-012-0175-y.
[31]Gall TM,Sodergren MH,Frampton AE,et al.Radio-frequencyassisted Liver Partition with Portal vein ligation(RALPP)for liver regeneration[J].Ann Surg,2015,261(2):e45-46.doi:10.1097/SLA.0000000000000607.