Yu Hui,Zheng Baijun,Gao Ya,et al.Total laparoscopic ALPPS in the treatment of massive liver tumor[J].Journal of Clinical Pediatric Surgery,,20():635-640,657.[doi:10.12260/lcxewkzz.2021.07.008]
Total laparoscopic ALPPS in the treatment of massive liver tumor
- Keywords:
- Laparoscopy; Liver Neoplasms; Hepatectomy; Child
- CLC:
- R735.7;R726.1
- Abstract:
- Objective To investigate the feasibility and therapeutic experience of total laparoscopic associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for massive liver tumor in children.Methods The clinical data of the girl diagnosed with massive liver tumor and treated by total laparoscopic ALPPS in the pediatric surgery department of the Second Affiliated Hospital of Xi’an Jiaotong University in July 2020 was retrospectively analyzed.The perioperative laboratory,imaging data and operation implementation were analyzed to evaluate the clinical application value of this operation in the treatment of pediatric massive liver tumor.Results The stage Ⅰ and Ⅱ of ALPPS were performed on July 11 and 24,2020,respectively.The operation time of stage I was 3 hours,and there was no blood transfusion during the perioperative period.The body temperature fluctuated 36.3-37.5℃within 3 days after operation,and the liver function returned to normal at the 10th days after operation.The postoperative ultrasound examination showed that the left portal vein was unobstructed,the inner diameter was 5.6 mm,the flow rate was 42 cm/s,and the volume of remnant liver increased from 221 cm3 to 394 cm3 on the third day after operation,with an increase rate of 78.28%.The operation time of stage Ⅱ was 6 hours.The liver function returned to normal at 36.3-37.8℃ within 3 days after operation,and the maximum abdominal drainage volume was 175 mL,and then gradually maintained at 20 mL/day.The catheter was clamped and discharged on the 13th day after operation.Conclusion Total laparoscopic surgery in children can safely and effectively carry out ALPPS for massive liver tumors,and reserve the residual liver for compensatory hyperplasia in a short period of time.It provides hope for children with massive liver tumors whose residual liver volume is not enough for complete resection,and is expected to become a new method for the treatment of massive liver tumors.
References:
1 周俭,王征,孙健,等.联合肝脏离断和门静脉结扎的二步肝切除术[J].中华消化外科杂志,2013,12(7):485-489.DOI:10.3760/cma.j.issn.1673-9752.2013.07.002. Zhou J,Wang Z,Sun J,et al.Associating liver partition and portal vien ligation for staged hepatectomy[J].Chin J Dig Surg,2013,12(7):485-489.DOI:10.3760/cma.j.issn.1673-9752.2013.07.002.
2 de Santiba?es E,Clavien PA.Playing play-doh to prevent postoperative liver failure:The "aLPPS" approach(Review)[J].Ann Surg,2012,255(3):415-417.DOI:10.1097/SLA.0b013e318248577d.
3 Schnitzbauer AA,Lang SA,Goessmann H,et al.Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J].Ann Surg,2012,255(3):405-414.DOI:10.1097/SLA.0b013e31824856f5.
4 王征,樊嘉,周俭.ALPPS在肝脏外科的应用前景[J].肝胆外科杂志,2015,23(1):1-2.DOI:10.3969/j.issn.1006-4761.2015.01.001. Wang Z,Fan J,Zhou J.Application prospect of ALPPS in liver surgery[J].Journal of Hepatobiliary Surgery,2015,23(1):1-2.DOI:10.3969/j.issn.1006-4761.2015.01.001.
5 Bertens KA,Hawel J,Lung K,et al.ALPPS:challenging the concept of unresectability-a systematic review[J].Int J Surg,2015,13:280-287.DOI:10.1016/j.ijsu.2014.12.008.
6 姚伟,董岿然,肖现民,等.联合肝脏离断和门静脉结扎二步肝切除术治疗儿童肝母细胞瘤一例报告[J].中华小儿外科杂志,2018,39(8):597-603.DOI:10.3760/cma.j.issn.0253-3006.2018.08.009. Yao W,Dong KR,Xiao XM,et al.Associating liver partition and portal vein ligation for staged hepatectomy for hepatoblastoma:a report of one case[J].Chin J Pediatr Surg,2018,39(8):597-603.DOI:10.3760/cma.j.issn.0253-3006.2018.08.009.
7 段怡涛,郑百俊,高亚,等.小儿腹腔镜下肝切除术4例[J].临床小儿外科杂志,2013,12(2):110-112,119.DOI:10.3969/j.issn.1671-6353.2013.02.010. Duan YT,Zeng BJ,Gao Y,et al.Laparoscopic liver resection in children:a report of 4 cases[J].J Clin Ped Sur,2013,12(2):110-112,119.DOI:10.3969/j.issn.1671-6353.2013.02.010.
8 郑百俊,段怡涛,高亚,等.腹腔镜小儿肝切除术21例报告[J].中华小儿外科杂志,2019,40(7):608-612.DOI:10.3760/cma.j.issn.0253-3006.2019.07.007. Zheng BJ,Duan YT,Gao Y,et al.Laparoscopic resection for hepatic masses in children:a report of 21 cases[J].Chin J Pediatr Surg,2019,40(7):608-612.DOI:10.3760/cma.j.issn.0253-3006.2019.07.007.
9 郑百俊,程继文,高亚,等.腹腔镜肝切除术与开腹肝切除术治疗肝母细胞瘤的临床效果比较[J].临床小儿外科杂志,2019,18(11):935-940.DOI:10.3969/j.issn.1671-6353.2019.11.008. Zheng BJ,Cheng JW,Gao Y,et al.Safety,feasibility and short-term outcome of laparoscopic liver resection versus open liver resection for hepatoblastoma[J].J Clin Ped Sur,2019,18(11):935-940.DOI:10.3969/j.issn.1671-6353.2019.11.008.
10 Schadde E,Ardiles V,Slankamenac K,et al.ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies:results of a multicenter analysis[J].World J Surg,2014,38(6):1510-1519.DOI:10.1007/s00268-014-2513-3.
11 Wiederkehr JC,Avilla SG,Mattos E,et al.Associating liver partition with portal vein ligation and staged hepatectomy (ALPPS) for the treatment of liver tumors in children[J].J Pediatr Surg,2015,50(7):1227-1231.DOI:10.1016/j.jpedsurg.2014.10.019.
12 刘连新.联合肝脏分隔和门静脉结扎的二步肝切除术基础研究进展[J].中华消化外科杂志,2016,15(5):441-443.DOI:10.3760/cma.j.issn.1673-9752.2016.05.008. Liu LX.Updates on associating liver partition and portal vein ligation for staged hepatectomy[J].Chin J Dig Surg,2016,15(5):441-443.DOI:10.3760/cma.j.issn.1673-9752.2016.05.008.
13 Hernandez-Alejandro R,Bertens KA,Pineda-Solis K,et al.Can we improve the morbidity and mortality associated with the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) procedure in the management of colorectal liver metastases?[J].Surgery,2015,157(2):194-201.DOI:10.1016/j.surg.2014.08.041.
14 Lau L,Christophi C,Muralidharan V.Intraoperative functional liver remnant assessment with indocyanine green clearance:another toehold for climbing the "ALPPS"[J].Ann Surg,2015,261(2):e43-e45.DOI:10.1097/SLA.0000000000000608.
15 Fukami Y,Kurumiya Y,Kobayashi S.Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):an analysis of tumor activity[J].Updates Surg,2014,66(3):223-225.DOI:10.1007/s13304-014-0256-1.
Memo
收稿日期:2021-03-22。
基金项目:国家自然科学基金（编号：82071692、81770513、81701501）；陕西省科技新星（编号：2019KJXX-044）；陕西省自然科学基金（编号：2020JM-407）；西安交通大学第二附属医院科技新苗项目[编号：RC（XM）201703]
通讯作者:高亚,Email:ygao@xjtu.edu.cn