在结直肠癌肝转移患者门静脉闭塞失败后，挽救性联合肝脏离断和门静脉结扎的二步肝切除术有效且安全。
Rescue ALPPS is efficient and safe after failed portal vein occlusion in patients with colorectal liver metastases.
作者信息
Sparrelid Ernesto, Gilg Stefan, Brismar Torkel B, Lundell Lars, Isaksson Bengt
机构信息
Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
出版信息
Langenbecks Arch Surg. 2017 Feb;402(1):69-75. doi: 10.1007/s00423-016-1524-y. Epub 2016 Oct 19.
PURPOSE
The aim of this study was to investigate whether associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can be used as an effective and safe rescue procedure in patients with colorectal liver metastases (CRLM) and insufficient effect on the future liver remnant (FLR) after previous portal vein occlusion (PVO).
METHODS
Eleven patients with bilobar CRLM treated with neoadjuvant chemotherapy and previous PVO with insufficient effect on the FLR were analyzed retrospectively from a prospective database. FLR was evaluated with computed tomography volumetry 6 days after stage 1, and stage 2 was performed on day seven.
RESULTS
Six days after stage 1, the median increase of the FLR was 209 ml (range 87-314, P < 0.001). This corresponded to a median FLR growth of 61.8 % (range 19.3-120) resulting in an FLR/BW ratio >0.5 % in all patients and successful subsequent removal of the tumor bearing liver (segments IV-VIII) in all patients with no 90-day mortality. No patient had a 3b-complication or more according to Clavien-Dindo. No patient developed severe posthepatectomy liver failure.
CONCLUSIONS
The powerful hypertrophy of the FLR associated with ALPPS seems to be maintained in patients with CRLM and previous failed PVO.
目的
本研究旨在探讨联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）能否作为结直肠癌肝转移（CRLM）患者及先前门静脉栓塞（PVO）后对未来肝残余量（FLR）影响不足时的一种有效且安全的挽救性手术。
方法
从一个前瞻性数据库中回顾性分析11例接受新辅助化疗且先前PVO后对FLR影响不足的双侧CRLM患者。在第1阶段术后6天用计算机断层扫描容积法评估FLR，并在第7天进行第2阶段手术。
结果
第1阶段术后6天，FLR的中位数增加量为209 ml（范围87 - 314，P < 0.001）。这相当于FLR中位数增长61.8%（范围19.3 - 120），所有患者的FLR/BW比值均>0.5%，所有患者均成功随后切除了含肿瘤的肝脏（IV - VIII段），且无90天死亡率。根据Clavien - Dindo分类，无患者出现3b级或更严重的并发症。无患者发生严重的肝切除术后肝功能衰竭。
结论
在CRLM且先前PVO失败的患者中，与ALPPS相关的FLR强大肥大似乎得以维持。
Zotero 插件