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

摘要： 【摘要】〓目的〓探讨联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)在具有乙肝肝硬化背景的巨块型肝癌中的应用价值。方法〓回顾性分析中山大学孙逸仙纪念医院肝胆外科25例ALPPS肝癌患者的临床资料,根据术后病理Ishak评分将患者分为轻中度与重度肝纤维化组,分析其与术后残肝体积代偿、手术间隔时间及预后的相互关系,分析门脉癌栓与ALPPS关系。附一例ALPPS一步术后,采取综合治疗患者资料。结果〓25例肝癌患者中成功完成第二步肝切除患者21例(84%),6个月内患者存活率为88%,目前患者存活率为76%。轻中度肝纤维化组与重度肝纤维化组相比,完成ALPPS二步肝切除患者分别为15例(94%)VS6例(67%),术前术后残肝体积分别为296 (194~401)mL VS 541(337~862)mL以及359(249~417)mL VS 519(178~709)mL;平均手术间隔分别为11(7~15)天以及23.57(12~64)天。3例肝功Child B级患者尝试行ALPPS手术,两例成功。合并门脉右支癌栓患者12例(II级),其中11例顺利完成二步肝切除;1例未能完成二步肝切除,改为综合治疗。结论〓ALPPS在轻中度肝纤维化患者中具有一定应用价值,重度肝纤维化背景下行ALPPS需慎重;门脉主干癌栓以下(I~II级)患者可以考虑尝试ALPPS。巨块型肝癌合并肝纤维化、门脉分支癌栓无法达到一期切除而其他治疗方法效果有限的情况下,尝试ALPPS第一步,若残肝代偿达到要求,则行ALPPS二步肝切除,实现根治性切除;若残肝代偿未达到要求,则可考虑在第一步基础上,采取综合治疗,患者仍有获得较好的预后及生存质量的可能。

关键词: ALPPS, 乙肝肝硬化, 肝癌