ALPPS may be an effective method for the treatment of low future liver remnant HCC patients with portal vein tumor thrombus
10.3760/cma.j.issn.1673-4203.2017.04.005
- VernacularTitle:ALPPS可能是治疗预留肝体积不足的伴门静脉癌栓肝细胞癌的有效方法
- Author:
Xiangfei MENG
;
Weidong DUAN
;
Yongwei CHEN
;
Shude CHEN
;
Xu HAN
;
Tianru MA
;
Lei BAO
;
Yingwei PAN
;
Lei HE
;
Shichun LU
- Keywords:
Association of liver partition and portal vein ligation for staged hepatectomy;
Portal vein tumor thrombosis;
Carcinoma,hepatocellular;
Future liver remnant;
Liver regeneration
- From:
International Journal of Surgery
2017;44(4):231-235,封3
- CountryChina
- Language:Chinese
-
Abstract:
Objective To provide the practical experience of association of liver partition and portal vein ligation for staged hepatectomy(ALPPS) procedure in portal vein tumor thrombosis(PVT) cases,and to explore its value in PVTT therapy.Methods Three cases of ALPPS were applied to PVTT in Department of Hepatobiliary Surgery of PLA General Hospital from 2015 to 2016.The patients data were retrieved and analyzed retrospectively,including the basic information,preoperative PVTT classification,preoperative Child-Pugh classification,ICG test results,future liver remnant (FLR),FLR growth rate between 2 phase operation,operation time,bleeding volume,postoperative complications,postoperative survival etc.We discussed the detail technology and discuss the surgical procedure combine our experience and the published papers.Results ALPPS was performed successfully in all 3 patients.According to the Cheng's Classification of PVTT,they were classified as type Ⅱ,1 case and Ⅲ type,2 cases.Preoperative liver function was Child-Pugh A grade,average ICG R15 was 7.3％ (4.2％-11.0％),and average FLR was 387 ml (333-484 ml).The mean time interval between 2 phases surgery was 24.7 days (9-50 days) and the average FLR growth rate was 50.3％ (24.4％-82.3％).Morbidity of Clavien-Dindo Ⅲ or more was recorded in 1 case,but no mortality occurred.During follow-up period,2 patients were treated with TACE for tumor recurrence.All patients survived with acceptable life quality till now.The portal vein tumor thrombosis necrosis was observed in all 3 specimens.Conclusions ALPPS is a valuable surgery for effective control of tumor thrombus and radical resection rate in well selected PVVT type Ⅱ and type Ⅲ patients.It is expected to improve the therapeutic effect in combination with TACE and other treatment methods.
