摘要
联合肝脏离断和门静脉结扎的二步肝切除(associated liver partition and portal vein ligation for staged hepatectomy,ALPPS)手术方案具有短期内残肝体积迅速增大的特点,在预估残肝体积(future liver remnant,FLR)不足的成人肝肿瘤手术中已获得推广。儿童肝脏肿瘤往往体积相对较大,尤其是肝母细胞瘤常侵犯多个肝段,或占据肝脏中央解剖部位,存在根治性肝切除术导致FLR不足的情况,有实施这一术式的价值。目前ALPPS在儿童肝脏肿瘤中的应用尚处于起步阶段。一般认为,术前评估FLR30%的病例可考虑实施本术式;术前应对患儿肝体积、肝功能以及肿瘤的可切除性进行精准评估;两次手术间隔时间以7~14 d为宜。手术并发症主要包括肝功能不足、出血和胆漏。关于儿童肝肿瘤中该术式的临床疗效评估尚待进一步总结。
Associated liver partition and portal vein ligation for staged hepatectomy( ALPPS) has the characteristics of rapid increase in volume of liver remnant in a short period of time. It has been popularized in adult liver tumor surgery for the prediction of insufficient future liver remnant( FLR). Children’s liver tumors are often relatively large,especially hepatoblastoma,which can invade multiple liver segments,or occupy the central anatomical site of the liver. Radical hepatectomy will be resulted in insufficient FLR in these cases,which may need the procedure of ALPPS. At present,the application of ALPPS in childhood liver tumors is still in developmental phase. In general,if one’s FLR is below 30% can be considered for ALPPS. So preoperative evaluation of the child’s liver volume,liver function,and tumor respectability should be performed accurately. The interval between two operation stages is 7 to 14 days. Surgical complications mainly include insufficient liver function,bleeding and bile leakage. The evaluation of the clinical efficacy of this procedure in children liver tumors needs to be further summarized.
作者
董岿然
Dong Kuiran(Department of Surgery,Pediatric Hospital Affiliated to Hehai University,Shanghai,201102,China)
出处
《临床小儿外科杂志》
CAS
2020年第5期382-385,共4页
Journal of Clinical Pediatric Surgery
基金
国家自然科学基金项目(编号:81572324)。
