关键词: ALPPS, 乙肝肝硬化, 肝癌

Abstract: 【Abstract】〓Objective〓To explore the applications of ALPPS in massive hepatocellular carcinoma with hepatitis B cirrhosis. Methods〓There was a retrospectively study using clinical data of 25 patients with hepatocellular carcinoma who accepted ALPPS from the Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. According to Ishak scoring system of the postoperative pathology,the patients were divided into two groups including mild-to-moderate liver cirrhosis and severe liver cirrhosis,which were then analyzed its relationship with postoperative liver volume compensation,interval time between surgeries and prognosis..Meanwhile the relationship between tumor emboli of portal vein and ALPPS was also analyzed. One supplement data of a patient taking comprehensive treatment after one stage of operation of ALPPS was attached here. Results〓In 25 patients, 21 patients (84%) completed the second stage of ALPPS, the survival rate was 88% within 6 months and 76% of them stay alive until now. Compared group of mild-to-moderate liver cirrhosis with group of severe liver cirrhosis, preoperative residual liver volume and postoperative residual liver volume was 296 ml (194 to 401 ml) VS 541 ml (337 to 862 ml) and 359 ml (249 to 417 ml) VS 519 ml (178 to 709 ml) respectively. Average operation interval time were 11 days (7-15 days) and 23.57 days(12-64 days). Three patients of Child class B accepted ALPPS and two of them succeed. 12 patients with tumor emboli in right branch of portal vein (level II) accepted ALPPS and 11 of them obtained ideal result. One of them failed to complete the second stage of the operation, but got a good prognosis after comprehensive treatment. Conclusion〓ALPPS has certain application value in patients with mild-to-moderate cirrhosis but requires further consideration in patients with severe cirrhosis and patients with tumor emboli in branches of portal vein (level I-II) may try to accept ALPPS. Patients of massive hepatocellular carcinoma along with moderate-to-severe cirrhosis and tumor emboli in branches of portal vein who cannot receive one stage resection or other effective therapies can consider accepting the first stage of ALPPS,.if the result meets the standard of the residual liver compensation, patients can continue the second stage of ALPPS. Otherwise, comprehensive treatment may lead to better prognosis and higher quality of life.

Key words: ALPPS, Hepatitis B cirrhosis, Hepatocellular carcinoma