Huang Hanchun, Lu Xin, Yang Huayu, Xu Yiyao, Sang Xinting, Zhao Haitao
Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Ann Transl Med. 2019 Dec;7(23):795. doi: 10.21037/atm.2019.11.99.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is used for avoiding postoperative live failure caused by insufficient future liver remnant (FLR) after major liver resection. However, ALPPS accompanied by high morbidity and mortality. The surgeons focus their attention mainly on the common complications such as bile leak, bleeding, infection and liver failure. Acute kidney injury (AKI) is a relatively rare postoperative complication, and get less attention. However, once AKI occurred after the surgery, it will seriously affect the prognosis of patients. We firstly report two cases of postoperative AKI after ALPPS in hepatocellular carcinoma with liver cirrhosis. Case 1, a 61-year-old male, chief complaint upper abdominal pain for half a month, medical examination found a huge liver space-occupying lesion. The clinical diagnosis was liver cancer, and ALPPS was performed. After the first step of surgery, delayed renal replacement therapy (RRT) was initiated when stage 3 AKI diagnosed. Although the second step surgery completed successfully, the patient eventually died of multiple organ dysfunction syndrome (MODS) induced by gastrointestinal bleeding. Case 2, a 64-year-old male chief complaint right liver mass present to our hospital, with a small FLR. Stage 2 AKI was diagnosed after the first step of ALPPS, early RRT was started immediately. Renal function gradually recovered, and the second step surgery was completed. The patient discharged with a good condition, found no recurrence in the latest follow-up. ALPPS for hepatocellular carcinoma with liver cirrhosis cases, more likely to happen AKI. More strict patient screening criteria, early RRT may improve the prognosis.
联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）用于避免大肝切除术后因未来肝残余量（FLR）不足导致的术后肝衰竭。然而，ALPPS伴随着高发病率和死亡率。外科医生主要关注胆汁漏、出血、感染和肝衰竭等常见并发症。急性肾损伤（AKI）是一种相对罕见的术后并发症，较少受到关注。然而，一旦手术后发生AKI，将严重影响患者的预后。我们首次报告了两例肝硬化肝细胞癌患者行ALPPS术后发生AKI的病例。病例1，一名61岁男性，主诉上腹部疼痛半个月，体检发现巨大肝脏占位性病变。临床诊断为肝癌，行ALPPS。在第一步手术后，当诊断为3期AKI时开始延迟肾脏替代治疗（RRT）。尽管第二步手术成功完成，但患者最终死于胃肠道出血诱发的多器官功能障碍综合征（MODS）。病例2，一名64岁男性，主诉右肝肿块来我院就诊，FLR较小。在第一步ALPPS后诊断为2期AKI，立即开始早期RRT。肾功能逐渐恢复，完成了第二步手术。患者康复出院，近期随访未发现复发。对于肝硬化肝细胞癌患者行ALPPS，更易发生AKI。更严格的患者筛选标准、早期RRT可能改善预后。
